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Differing Forms, Differing Purposes: A Typology of Health Impact Assessment

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Abstract

There is currently considerable diversity in health impact assessment (HIA) practice internationally. Historically this diversity has been described as simple dichotomies, for example the differences between HIAs of projects and policies. However these distinctions have failed to adequately describe the differences that can be observed between different forms of HIAs. This paper describes the three historical and disciplinary fields from which HIA has emerged — environmental health, a social view of health, and health equity. It also puts forward a typology of four different forms of HIA that can be observed in current HIA practice: mandated, decision-support, advocacy, and community-led HIAs. This paper argues that these different forms of HIA serve different purposes and are not necessarily in competition; rather they allow HIA to be responsive to a range of population health concerns and purposes.

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... Reviews carried out analysing how health is considered within EIA tend to emphasise a narrow biomedical interpretation of health within EIA with a focus on environmental determinants of health [3]. This contrasts with HIA literature that tends to emphasize a broader conceptualisation of health [5,6]. Implicit (and sometimes explicit) within the literature are differences between disciplinary and paradigm perspectives-a so called paradigm war where paradigm and related epistemological and methodological differences are seen as incommensurate [7]. ...
... Both HIA and EIA are concerned with creating knowledge about the potential impacts of an activity (be it a policy, project, or programme). We (and others) believe that the dominant disciplines within EIA and HIA fields tend to have different paradigm perspectives [4,5,11,12]. EIA is largely positivist in epistemological origin [5] and draws strongly on fields of biological sciences, epidemiology, toxicology, risk assessment, cost-benefit analysis, ecology, and increasingly sociological disciplines [12]. ...
... We (and others) believe that the dominant disciplines within EIA and HIA fields tend to have different paradigm perspectives [4,5,11,12]. EIA is largely positivist in epistemological origin [5] and draws strongly on fields of biological sciences, epidemiology, toxicology, risk assessment, cost-benefit analysis, ecology, and increasingly sociological disciplines [12]. HIA, when it emerged as a field in the 1990s, had two main drivers; EIA and Healthy Public Policy [13]. ...
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Background: The fields of Health Impact Assessment (HIA) and Environmental Impact Assessment (EIA) have grown with increasing numbers of disciplines and sectors contributing to their advancements, but with it, perceived conflict over methodological and disciplinary approaches to integrate health in impact assessments. This study maps the current field of HIA and health in EIA to examine the scientific landscape of the field. Methods: We carried out a bibliometric analysis of HIA papers and EIA papers that included a health focus in peer-reviewed journals in the Web of Science Core Collection (n = 229). We carried out co-authorship and co-citation network analyses of authors and documents in VOSviewer. Results: We identified two main co-authorship and co-citation groupings. Our document co-citation analysis also identified four clusters with two major groups, the Defining HIA cluster and the Describing the fields cluster versus the Active transport quantitative HIA cluster, and the Quantitative modelling tools cluster. Conclusion: Our findings strongly suggest that there exist two groups of thought in the scholarly fields of HIA and health in EIA. Barriers to developing more methodologically integrated approaches to considering health within EIA are related more to disciplinary differences than field (HIA versus EIA)-based differences and we advocate for the development of transdisciplinary approaches to both HIA and EIA.
... From late 1980s, this approach was widening by considering not only the models and determinants explaining the health status of the population, but also how certain factors (unemployment, unsafe workplaces, housing deprivation, etc.) contribute to health disparities within a population both at group and individual level (Wilkinson and Marmot 2003 ;Sen 2004 ;Gehlert et al. 2008 ;Harris-Roxas and Harris 2011 ). Analyzing social, environmental, and working conditions as upstream factors in multilevel models can improve the design and implementation of interventions targeted at levels downstream from those conditions (Gehlert et al. 2008 ). ...
... HIA intends to assist decision makers by providing a set of evidence-based recommendations on the causal pathways that link the different possible scenarios related to the implementation of a policy to potential health outcomes through a set of upstream health determinants and downstream risk factors (Kemm 2001(Kemm , 2007Mindell 2002 , 2006 ;Metcalfe and Higgins 2009 ). Its ultimate goal is to support the development of healthy policies by adjusting the design or adding new components to original proposals that maximize health gains, and minimize negative outcomes and health inequalities (Joffe and Mindell 2005 ;Mindell et al. 2008 ;Harris-Roxas and Harris 2011 ). ...
... The most widely current practice of HIA takes as a reference the social view of health and equity, which as described above, gives a great importance to health determinants linked to interventions from non-health sectors (i.e., economy, agriculture, housing, occupation, transport), and to major equity indicators (gender, ethnicity and social class) (Metcalfe and Higgins 2009 ; Solar and Irwin 2010 ). In this way, HIA has been considered as a promising tool for promoting an effective implementation of the HiAP strategy, as well as for addressing potential health inequalities that might arise from a proposal (European Commission 2007 ;Wismar et al. 2007 ;WHO-Government of South Australia 2010 ;Harris-Roxas and Harris 2011 ;McQueen et al. 2012 ;Kemm 2013 ). Furthermore, HIA intends to promote coordinated cross-governmental actions, and a better understanding of the decision making process, adding transparency and democracy by involving other stakeholders (Kemm 2007 ;Salay and Lincoln 2008 ). ...
Chapter
The European Union, first at the Treaty of Maastricht and more explicitly at the Amsterdam Treaty, declared that “a high level of health protection shall be ensured at the definition and implementation of all Community policies activities.” The strategy of “Health in All Policies” (HiAP), adopted at the Finnish European Union (EU) Council Presidency in 2006, has become increasingly important in Europe as governments realize that reducing inequalities and improving health are fundamental enablers for economic development. The second programme of Community action in the field of health (2008–2013) of the European Parliament and Council also calls “to support the mainstreaming of health objectives in all Community policies and activities.” The increasing call for a better protection of citizen’s health demands a better understanding of the existing forms for characterizing health impacts of policies, and the purposes for which they are undertaken. Differences in concepts, frameworks and procedures among various approaches (risk assessment, health impacts assessment, etc.) have arisen in relation to specific issue of concern (i.e., waste disposal; electromagnetic fields, biotechnology, social disparities, urban planning, etc.), or due to perceived weakness in practice (i.e., the food safety crisis that took place in late 1980s and 1990s as the occurrence of BSE (mad-cow)). The present chapter intends to provide an overview of some of those approaches, especially risk assessment for health and health impact assessment, considering them in the political context they appeared, and the purpose they have been applied for. Finally some attention will be paid to the process called “policy evaluation,” as a different tool used in the improvement of healthy policy formulation and practice.
... Critically, the different definitions of health and the divide between those working in public health and those working in EIA is not attributed to procedural compliance with the regulations and legislation which provide a mandate for EIA. It is instead attributed variously to the origins of the crossover between health and environmental assessment being in an environmental health tradition [58], to the predominance of the regulatory agencies in EIA, to the absence of health expertise in the EIA practitioner community and to entrenched EIA practices [56]. Commentators have noted how the absence of guidance documents addressing the particularities of health in EIA is a barrier to the inclusion of health into environmental assessments [48] and how this, in turn, leads practitioners to fall back on environmental health statutes to define the scope of the health concerns [56]. ...
... McCallum et al. [97] set out three methodological considerations for enabling integration of health into EIA and smooth cross-sectoral work: (A) Ensure that the framework can be used as a stand-alone process and when integrated with EIA. Health in EIA needs to be consistent with HIA frameworks and to ensure 'public health' values [58] and approaches inform practice. The reference paper establishes overarching principles: a comprehensive approach to health; a focus on equity; an approach that is proportionate; and that is consistent with science while taking local context into account. ...
... As discussed above (see Section 4.1), the way in which health is addressed in EIA is not due to procedural compliance with the regulations and legislation which provide a mandate for EIA but to tradition [58], to the regulatory agencies in EIA, to the absence of health expertise in the EIA practitioner community and to entrenched EIA practices [56]. This suggests that in the absence of guidance, the business-as-usual coverage of population and human health in EIA risks defaulting to low levels of input from the health sector and variable methods and standards in the way that health is addressed and judged. ...
Article
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Environmental Impact Assessment (EIA) is applied to infrastructure and other large projects. The European Union EIA Directive (2011/92/EU as amended by 2014/52/EU) requires EIAs to consider the effects that a project might have on human health. The International Association for Impact Assessment and the European Public Health Association prepared a reference paper on public health in EIA to enable the health sector to contribute to this international requirement. We present lessons from this joint action. We review literature on policy analysis, impact assessment and Health Impact Assessment (HIA). We use findings from this review and from the consultation on the reference paper to consider how population and human health should be defined; how the health sector can participate in the EIA process; the relationship between EIA and HIA; what counts as evidence; when an effect should be considered ‘likely’ and ‘significant’; how changes in health should be reported; the risks from a business-as-usual coverage of human health in EIA; and finally competencies for conducting an assessment of human health. This article is relevant for health authorities seeking to ensure that infrastructure, and other aspects of development, are not deleterious to, but indeed improve, human health.
... Study of n-alkanes and PAHs distribution provides to distinguish between anthropogenic and biogenic sources, moreover, the diagnostic ratios can be used to determine their sources (Asia et al., 2009). Principally, n-alkanes are, generally, used to make a broad overview of hydrocarbon sources ranging from terrestrial vascular plant materials to marine algae to petroleum (Harris-Roxas and Harris, 2011). PAHs molecular indices allow to discriminate between pyrogenic and petrogenic sources because pyrogenic PAHs are generated by partial organic matter combustion at high temperature, and petrogenic PAHs are closely related to crude oil and its refined products (Commendatore and Esteves, 2004;Guo et al., 2012;Maliszewska-Kordybach et al., 2009;Page et al., 2002;Wang et al., 1999b). ...
... Values higher than 1 of these ratios are characteristic of petroleum origin, whereas values lower than 1 are related to pyrolytic origins (Budzinski et al., 1997). The limits among the two ratios are not precise, and more indices must be observed simultaneously to provide more accurate estimate of the different PAH sources (de LR Wagener et al., 2012;Harris-Roxas and Harris, 2011;Soclo et al., 2000;Yunker et al., 2002). Since Ant / (Ant + Phe) is useful to distinguish combustion from petroleum sources, Flu / (Flu + Py) can be applied to differentiate petroleum combustion from other types of combustion. ...
Article
The distribution and sources of PAHs and n-alkanes were determined in the surface sediments from 202 locations in Shadegan international wetland with 537,700 ha. The concentrations of total n-alkanes and PAHs ranged from 395.3 to 14933.46 μg g− 1 dw and 593.74 to 53393.86 ng g− 1 dw, respectively. Compared with other worldwide surveys, the concentration and contamination of sedimentary hydrocarbons were classified very high. A common petrogenic hydrocarbon source was strongly suggested in all sites by n-alkanes' profile with a Cmax at n-C20, Pr/Ph and CPI ratios < 1 in all sites, and high percentage of UCM. Typical profile of petrogenic PAHs with alkyl-substituted naphthalenes and phenanthrenes predominance, various PAH ratios and multivariate analysis indicated that PAHs were mainly derived from petrogenic source. Naphthalene-derived compounds in all sites were significantly above their ERL, and adversely affected benthic biota. 92% of the sites had mean ERM values < 0.1, indicating high ecological risk on the wildlife of the wetland.
... The Gothenburg consensus paper also defines the values governing HIA: democracy, equity, sustainable development, and ethical use of evidence. First discussions on the need of assessing health impacts within the context of major development projects (Morris & Novak, 1976), HIA has by now spread around the world (Harris-Roxas and Harris, 2011) and is promoted by institutions such as WHO and, to some extent, by IFC and industry associations. ...
... With a focus on social determinants and equity, HIA shares considerable grounds with health promotion, which is mostly based on an empowerment oriented approach (Harris-Roxas & Harris, 2011). This perspective positions HIA as resource for an "empowered citizen" to request for the conduct of HIA if there is some suspicion that an investment could harm health. ...
Book
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Prospective impact assessment is a consolidated approach for pursuing foresight in policy and decision-making, systematically deployed worldwide. There is consensus that, even in well developed impact assessments, human health is not always covered adequately. Partly as a response, health impact assessment (HIA) has emerged and has been applied in several countries in Europe and beyond. Opinions about the merits of HIA separate from other forms of impact assessment differ.This publication aims to provide a detailed and balanced view on “health in impact assessments” . Five key types of impact assessment, namely environmental impact assessment, strategic environmental assessment, social impact assessment, sustainability assessment, and HIAare presented, and four key questions are discussed: How can the various assessments contribute to promoting and protecting human health? How can further integration of health support the various forms of impact assessments? What forms of integration seem advisable? What priorities for further development? This analysis suggests that the potential of impact assessments to protect and promote health is underutilized, and represents a missed opportunity. Ways need to be found to exploit the potential to a fuller extent. Full text: www.euro.who.int/health-in-IA.
... In HICs, benefits of HIAs have been proven to outweigh the cost of undertaking them and not the contrary [41]. However, evidence shows that policy makers decline HIA use because they incorrectly believe that HIAs are 'expensive and time-consuming', both in HICs and LMICs [29,137]. Earlier, Kemm (2005) reported the need of conducting cost-benefit analysis of HIA as an important element and low-hanging fruit for progress [134]. ...
... In LMICs, both availability and quality of data should dictate whether a HIA is conducted or not; after which HIA frameworks need to be adapted to what can be done with the resources (human, financial, and time) at hand. A thorough understanding of HIA typologies (see Harris-Roxas (2011)) [137] can be helpful to identify the type of HIA most fitting for conducting a quality HIA with available data. For instance, the choice of running a rapid, intermediate or comprehensive HIA can significantly influence the scope, impact, and ultimately the action taken upon HIA estimates. ...
Article
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Health Impact Assessments (HIAs) motivate effective measures for safeguarding public health. There is consensus that HIAs in low and middle-income countries (LMICs) are lacking, but no study systematically focuses on those that have been successfully conducted across all regions of the world, nor do they highlight factors that may enable or hinder their implementation. Our objectives are to (1) systematically review, geographically map, and characterize HIA activity in LMICs; and (2) apply a process evaluation method to identify factors which are important to improve HIA implementation in LMICs. A systematic review of peer-reviewed HIAs in 156 LMICs was performed in Scopus, Medline, Web of Science, Sociological abstracts, and LILACs (Latin American and Caribbean Health Sciences) databases. The search used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and covered HIAs across all type of interventions, topics, and health outcomes. HIAs were included if they reported a clear intervention and health outcome to be assessed. No time restriction was applied, and grey literature was not included. The eligible studies were subjected to six process evaluation criteria. The search yielded 3178 hits and 57 studies were retained. HIAs were conducted in 26 out of 156 countries. There was an unequal distribution of HIAs across regions and within LMICs countries. The leading topics of HIA in LMICs were air pollution, development projects, and urban transport planning. Most of the HIAs reported quantitative approaches (72%), focused on air pollution (46%), appraised policies (60%), and were conducted at the city level (36%). The process evaluation showed important variations in the way HIAs have been conducted and low uniformity in the reporting of six criteria. No study reported the time, money, and staff used to perform HIAs. Only 12% of HIAs were based on participatory approaches; 92% of HIAs considered multiple outcomes; and 61% of HIAs provided recommendations and fostered cross-national collaboration. The limited transparency in process, weak participation, and inconsistent delivery of recommendations were potential limitations to HIA implementation in low and middle-income countries. Scaling and improving HIA implementation in low and middle-income countries in the upcoming years will depend on expanding geographically by increasing HIA governance, adapting models and tools in quantitative methods, and adopting better reporting practices.
... In addition to diversity in the types of HIA being practised, there is a broad range of fields of HIA application [40]. While HIA practitioners currently have the most experience in HIA of projects, a lot of experience also exists in other application fields (i.e., policies, plans, programmes, and strategies). ...
... While HIA practitioners currently have the most experience in HIA of projects, a lot of experience also exists in other application fields (i.e., policies, plans, programmes, and strategies). This confirms the finding of previous research, indicating that international HIA practice has moved beyond the simple dichotomy of HIAs of projects and policies [40]. ...
Article
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Health impact assessment (HIA) practice has expanded across the world, since it was established more than two decades ago. This paper presents a snapshot of current global HIA practice based on the findings of an online questionnaire survey. HIA practitioners from all world regions were invited to participate. A total of 122 HIA practitioners from 29 countries completed the survey, following a broad international outreach effort. The large variety in the types of HIAs conducted, and the application of HIA in various fields reported by respondents, demonstrates that HIA practice has evolved over the past two decades. Although differences in the use of HIA were reported across world regions, an overall increasing trend in global HIA practice can be observed. In order to sustain this upward trend, efforts are needed to address the main barriers in the utilisation of HIA. The establishment of new national and international HIA teaching and training offerings seems to be an obvious strategy to pursue along with the strengthening of policies and legal frameworks that specify the circumstances, under which HIA is required, and to what extent.
... À l'échelle mondiale, l'EIS est mise en oeuvre dans plusieurs contextes et fait preuve d'une grande flexibilité quant à ses modalités d'application. L'expérience internationale a démontré que, même si les EIS s'appuient toutes sur la démarche promue par l'Organisation mondiale de la santé (OMS) depuis le Consensus de Gothenburg de 1999 (6), le contexte dans lequel elles se déroulent ainsi que la finalité recherchée par les praticiens influencent leur processus d'application (7). Selon Harris-Roxas et Harris (7) La distinction effectuée entre les différents modèles d'application des EIS démontrent que le recours à l'un d'eux ne repose pas sur la préférence ou la supériorité intrinsèque d'un modèle par rapport aux autres, mais dépend plutôt du contexte dans lequel une EIS est mise en oeuvre et des opportunités de collaboration existantes. ...
... Selon Harris-Roxas et Harris (7) La distinction effectuée entre les différents modèles d'application des EIS démontrent que le recours à l'un d'eux ne repose pas sur la préférence ou la supériorité intrinsèque d'un modèle par rapport aux autres, mais dépend plutôt du contexte dans lequel une EIS est mise en oeuvre et des opportunités de collaboration existantes. Toutefois, même si tous ces modèles se révèlent appropriés pour répondre aux différents contextes d'application dans lesquels les EIS sont mises en oeuvre, le modèle de soutien à la prise de décision se révèle potentiellement plus approprié pour favoriser la prise en compte des recommandations dans les processus décisionnels (7,8). ...
Article
Le présent article fait état du modèle de soutien à la prise de décision appliqué à l’évaluation d’impact sur la santé (EIS) en Montérégie, au Canada. Pour répondre à la volonté de soutenir l’élaboration de politiques et projets municipaux favorables à la santé et fondés sur les données probantes, la Direction de santé publique a mis en œuvre une démarche d’EIS dont les fondements pratiques s’inspirent des expériences internationales en matière d’EIS et dont les assises théoriques reposent sur le partage et le courtage de connaissances. L’expérience montérégienne démontre que la stratégie de courtage de connaissances appliquées à l’EIS encourage un partage respectueux des responsabilités et rôles de chacune des parties prenantes et favorise l’utilisation des connaissances de santé publique dans la prise de décision municipale. Le courtage des connaissances permet de prendre en compte les enjeux locaux dans les analyses d’impact et dans les recommandations aux décideurs. En conclusion, il s’avère que l’implication des décideurs municipaux à la recherche de solutions favorables à la santé permet d’inscrire les données probantes à l’intérieur des processus décisionnels et d’observer leur utilisation à plusieurs niveaux. L’évaluation des premières expériences d’EIS révèle en effet que les connaissances partagées répondent à des besoins immédiats engendrant leur utilisation directe, contribuent à des changements de perception et de pratique à plus large échelle et font de la santé une valeur reconnue par les décideurs publics et promue auprès de leurs citoyens pour accroître l’acceptabilité des initiatives municipales.
... Over the past two decades, the use of health impact assessment (HIA) has grown rapidly (Harris-Roxas et al. 2012) and this is most likely attributable to the increased combined efforts of the three complementary areas of policy concern and activity: environmental health, the wider determinants of health and health equity, all of which are integral components in HIAs (Harris-Roxas and Harris 2011;Harris-Roxas et al. 2012). The fundamentals of HIAs are concerned with how the health and well-being of a population could be affected by a proposed policy, plan or action and the widely accepted key definition of HIA is that of the Gothenburg Consensus (WHO 1999), which describes HIA as 'a combination of procedures, methods and tools by which a policy, programme or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population'. ...
Article
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The use of health impact assessments (HIAs) has rapidly increased over the last two decades and has been undertaken to evaluate the health implications of many new projects across the globe. In July 2017, Wales became the first country to legislate for broad approach HIAs, i.e. it considers not only environmental health effects but the social determinants of health, well-being and inequalities. Although the introduction of statutory HIA will ensure the use of HIAs, experts have expressed concerns that legislative measures could lead to poor-quality HIAs and associated reports. This paper outlines the development process and analytical reflections of a quality assurance (QA) review framework for HIAs. The framework has been developed over a 2-year period which allowed the collective intellectual capital behind it to evolve in response to practice-based learning. A standardised form of QA for all types and levels of HIA will provide greater clarity regarding the required criteria for conducting and completing an HIA and ensuring this takes place in a robust, interdisciplinary and inter-sectoral manner. Therefore, this QA review framework should fit into existing HIA practice and complement other tools such as best practice guidance to sustain the global reputation of HIA.
... HIA can also be used as a systematic process to determine the potential health effect of i.e. air pollution from proposed policies, plans, programs or projects and can provide recommendations on monitoring and managing those effects (Chart-asa and Gibson, 2015). Results from HIA can thereby be a useful tool for policymakers and urban planners (Harris-Roxas and Harris, 2011;Shojaei et al., 2014). For example, Castro and colleagues estimated the health impacts attributable to a decrease in particulate matter with an aerodynamic diameter < 10 μg/ m 3 (PM 10 ) and Nitrogen Dioxide (NO 2 ) concentrations due to certain policy measures to be about 1% to 2% of total all-cause annual mortality in the population of the Agglomeration Lausanne-Morges in Switzerland (Castro et al., 2017). ...
Article
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Air pollution is responsible for one in eight premature deaths worldwide, and thereby a major threat to human health. Health impact assessments of hypothetic changes in air pollution concentrations can be used as a mean of assessing the health impacts of policy, plans and projects, and support decision-makers in choices to prevent disease. The aim of this study was to estimate health impacts attributable to a hypothetical decrease in air pollution concentrations in the city of Malmö in Southern Sweden corresponding to a policy on-road transportations without tail-pipe emissions in the municipality. We used air pollution data modelled for each of the 326,092 inhabitants in Malmö by a Gaussian dispersion model combined with an emission database with >40,000 sources. The dispersion model calculates Nitrogen Oxides (NOx) (later transformed into Nitrogen Dioxide (NO2)) and particulate matter with an aerodynamic diameter < 2.5 μg/m³ (PM2.5) with high spatial and temporal resolution (85 m and 1 h, respectively). The average individual reduction was 5.1 (ranging from 0.6 to 11.8) μg/m³ in NO2, which would prevent 55 (2% of all deaths) to 93 (4%) deaths annually, depending on dose-response function used. Furthermore, we estimate that the NO2 reduction would result in 21 (6%) fewer cases of incident asthma in children, 95 (10%) fewer children with bronchitis every year, 30 (1%) fewer hospital admissions for respiratory disease, 87(4%) fewer dementia cases, and 11(11%) fewer cases of preeclampsia every year. The average reduction in PM2.5 of 0.6 (ranging from 0.1 till 1.7) μg/m³ would mean that 2729 (0.3%) work days would not be lost due to sick-days and that there would be 16,472 fewer restricted activity days (0.3%) that year had all on-road transportations been without tail-pipe emissions. Even though the estimates are sensitive to the dose-response functions used and to exposure misclassification errors, even the most conservative estimate of the number of prevented deaths is 7 times larger than the annual traffic fatalities in Malmö, indicating a substantial possibility to reduce the health burden attributed to tail-pipe emissions in the study area.
... Such an indicator-based CuBA can be used to identify populations and places that are subjected to both elevated environmental exposures and lack economic, political and social resources for either avoiding or adapting to the actual environmental situation. In contrast to a health impact assessment, which quantifies potential health impacts of a given plan or development project [13], a CuBA serves as a screening tool to identify 'hotspots' that require additional study, investments, or other precautionary actions [9,10,14]. Therefore, conducting a CuBA offers opportunities for addressing environmental health related socio-spatial inequalities in planning and policy processes. ...
Article
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Cumulative burden assessment (CuBA) has the potential to inform planning and decision-making on health disparities related to multiple environmental burdens. However, scholars have raised concerns about the social complexity to be dealt with while conducting CuBA, suggesting that it should be addressed in an adaptive, participatory and transdisciplinary (APT) approach. APT calls for deliberation among stakeholders by engaging them in a process of social learning and knowledge co-production. We propose an interactive stakeholder-based approach that facilitates a science-based stakeholder dialogue as an interface for combining different knowledge domains and engendering social learning in CuBA processes. Our approach allows participants to interact with each other using a flexible and auditable CuBA model implemented within a shared workspace. In two workshops we explored the usefulness and practicality of the approach. Results show that stakeholders were enabled to deliberate on cumulative burdens collaboratively, to learn about the technical uncertainties and social challenges associated with CuBA, and to co-produce knowledge in a realm of both technical and societal challenges. The paper identifies potential benefits relevant for responding to social complexity in the CuBA and further recommends exploration of how our approach can enable or constraint social learning and knowledge co-production in CuBA processes under various institutional, social and political contexts.
... A peer review typology should consider the HIA steps as well as the different typologies of practice (Harris-Roxas et al., 2011). The type of review should be expanded or minimized according to time and resources in accordance with the type of HIA (rapid, comprehensive, etc.). ...
Article
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p> Background: While HIA guidelines and practice standards are used throughout the field, peer review is a potentially untapped resource for HIA practitioners in the US and potentially internationally. Peer review is thought to strengthen HIA practice, although very few guidance documents exist, and there has been little research to date on the efficacy of peer review for improving HIAs. Methods: To explore the possible value of peer review in HIA, an expert panel was convened at the 2013 HIA of the Americas Workshop, and an online survey was used to query HIA practitioners regarding their experience with and motivation for HIA peer review. Results: Most survey respondents (n=20 out of 26) indicated that peer review in HIA was helpful, and 15 respondents thought a formal peer review process would improve HIA practice. Respondents wanted peer review to be timely and the reviewer to approach the review as a mentor rather than a gatekeeper. Conclusion: This paper offers the initial development of a peer review typology based on feedback from the online survey and workshop participants. Better understanding of the potential challenges and opportunities for using peer review in HIA may help to improve HIA practice.</p
... Explicit research on the use of assessment tools within the context of EPH advocacy is rather new and under-discussed, with only some noteworthy examples (Cohen et al., 2015;Lane, 2018). Literature contribution comes from other seemingly unrelated yet equally valuable sources, such as from reviews of established international organizations (Barrett et al., 2016;IOB Evaluation, 2015;Oxfam, 2014), from generalized academic frameworks (Chapman & Wameyo, 2001;Moore et al., 2013) and from related fields within public health research (Cullerton et al., 2018;Harris-Roxas & Harris, 2011;Kemm, 2001;Veerman, Barendregt, et al., 2006;Veerman, Bekker, et al., 2006). Some studies have delved in analysing purely the 'advocacy' dimension of public health (Chapman, 2001(Chapman, , 2004David et al., 2020), while few studies reviewed also the role of nurses organizations in the process of policy influence and advocacy (Arabi & Ra, 2014;Catallo et al., 2014;Chiu et al., 2021;Moore et al., 2013;Spenceley et al., 2006;van Wijk et al., 2022). ...
Article
Advocacy is an intentional act of influencing government and an important precondition for successful policy change in society. Drawing from an existing framework on policy influence, we propose an approach to quantifying the impact of policy influence efforts, specifically within the context of European Public Health (EPH) advocacy. The analysis hinges on the article “Moving from tokenism” which provides a starting point to conceptualize strategies to quantify impact. An exploratory case study approach allowed to integrate literature on advocacy evaluation in parallel with the internal documentation of a EPH advocacy organization We provide recommendations to advocacy organizations that aim to create an infrastructure towards quantifying the impact of their efforts. The framework is mostly tailored to the needs of EPH advocacy, but it can also have resonance beyond the scope of a specific sector.
... One tool to support greater awareness and consideration of the potential health effects of decisions made outside the health sector is health impact assessment (HIA) Harris-Roxas & Harris, 2011). HIA is defined as "a systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential effects of a proposed policy, program, or project on the health of a population and the distribution of those effects within the population. ...
Article
Policies, programs, and projects related to agriculture, food, and nutrition can significantly affect public health. Health impact assessment (HIA) is one tool that can be used to improve awareness of the health effects of decisions outside the health sector, and increasing the use of HIA for agriculture, food, and nutrition decisions presents an opportunity to improve public health. This study identifies and reviews all HIAs completed in the United States on agriculture, food, and nutri­tion topics. Studies were identified from HIA databases, an Internet search, and expert consulta­tion. Key characteristics were extracted from each study: type of decision assessed, location, level of jurisdic­tion, lead organization, methods of analysis, and recommendations. Twenty-five eligible HIAs that were conducted between 2007 and 2016 address topics such as regulations on land use for agricul­ture; food and beverage taxes; and devel­oping gro­cery stores in food deserts. These HIAs have predominantly supported policy, as opposed to program or project, decisions. Four case studies are presented to illustrate in detail the HIA process and the mechanisms through which HIA findings affected policy decisions. Among other influences, these four HIAs affected the language of legislation and provided guidance for federal regulations. These examples demonstrate several findings: appropriate timing is critical for findings to have an influence; diverse stakeholder involvement gener­ates support for recommendations; and the clear communication of feasible recommendations is highly important. There is substantial scope to increase the use of HIA in the agriculture, food, and nutrition sectors. Challenges include the pau­city of monitoring and evaluation of HIAs’ effects on health outcomes, and the limited funding availa­ble to conduct HIAs. Opportunities include inte­grating HIAs and community food assessments, and more widely sharing HIA findings to inform related decisions in different jurisdictions and to increase support for additional HIAs that address the food system. Note: See the supplemental Excel file (under Article Tools>Supplementary files at left) for more details on the health impact assessments included in this systematic review.
... Health Impact Assessment (HIA) uses scientific evidence, professional expertise, and stakeholder input to evaluate the different paths through which proposed policies, plans, and projects may affect health, and makes recommendations to maximize benefits and minimize risks [1][2][3]. Internationally, HIA may be conducted for various reasons; HIA may be mandated, serve as a decision-support instrument, be used as an advocacy tool, or constitute a community led effort to understand proposed local change [4]. In the United States HIA is generally not mandated, but is voluntarily used to analyze proposed actions through a health lens. ...
Article
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Health Impact Assessment (HIA) courses are teaching public health and urban planning students how to assess the likely health effects of proposed policies, plans, and projects. We suggest that public health and urban planning have complimentary frameworks for training practitioners to address the living conditions that affect health. Planning perspectives emphasize practical skills for impacting community change, while public health stresses professional purpose and ethics. Frameworks from both disciplines can enhance the HIA learning experience by helping students tackle questions related to community impact, engagement, social justice, and ethics. We also propose that HIA community engagement processes can be enriched through an empathetic practice that focuses on greater personal introspection.
... As time progressed, both SIA and HIA evolved into separate practices, used in instances not warranting an EIA (Arce-Gomez et al., 2014;Harris-Roxas and Harris, 2010;Mindell and Joffe, 2003). ...
Conference Paper
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In order to balance resources between the tiers of the healthcare facility hierarchy in a way that ensures optimal healthcare provision, it is important that decisions concerning the expansion of the healthcare service provision network should align with a clearly defined strategy. In this paper, we evaluate the need for a custom framework for the retrospective assessment of the impact of a new healthcare facility. Perspectives from which a new facility are to be evaluated include: (i) the impact on the healthcare provision network as a whole; (ii) the impact on the total healthcare provision cost for the catchment area; and (iii) the impact on healthcare outcomes amongst the population that a facility serves. In order to evaluate the requirements of the new methodology, the basic structures of a range of existing methodologies are juxtaposed before establishing the healthcare indicators used in the annual health reports of three distinct countries.
... Qu'est-ce qui distingue l'ÉIS par rapport aux autres pratiques de santé publique cherchant à influencer les politiques ou les projets pour les rendre favorables à la santé? Les frontières qui délimitent la pratique de l'ÉIS sont souvent discutées (Fakhri, Maleki, Gohari et Harris, 2014;Harris, Kemp et Sainsbury, 2012;Harris-Roxas et Harris, 2010;Kemm, 2013;Kemm, Parry et Palmer, 2004). Cette question est d'autant plus importante que l'ÉIS doit s'adapter au contexte spécifique de son application, sans toutefois perdre sa spécificité. ...
Article
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L’évaluation d’impact sur la santé (EIS) suscite aujourd’hui en France un réel intérêt et la pratique ne cesse de progresser, motivée par une préoccupation commune des villes et des institutions régionales de la santé, de contribuer ensemble à l’amélioration de la santé et à la réduction des inégalités sociales de santé. Cette démarche a pour but d’identifier les conséquences potentielles de politiques ou projets sur la santé des populations afin de proposer des mesures destinées à atténuer les impacts négatifs et renforcer les impacts positifs. L’objectif de cet article est d’apprécier dans quelle mesure et par quels mécanismes l’EIS facilite l’intégration de la dimension santé dans les politiques urbaines.
... HIA seeks to systematically judge the potential (and sometimes unintended) effects of a policy, project, or other intervention upon population health as well as the distribution of those effects. Both a process and a method of analysis, HIA aims for transparent decision-making, integrating multiple health determinants, and assessing the short-and long-term health impacts upon specific groups and general population health [73]. Some local and national governments have formally institutionalized HIA as a distinct practice in public health and other agencies; other governments integrate HIA into existing health analyses and public decision-making analyses. ...
Article
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Informal settlement upgrading is widely recognized for enhancing shelter and promoting economic development, yet its potential to improve health equity is usually overlooked. Almost one in seven people on the planet are expected to reside in urban informal settlements, or slums, by 2030. Slum upgrading is the process of delivering place-based environmental and social improvements to the urban poor, including land tenure, housing, infrastructure, employment, health services and political and social inclusion. The processes and products of slum upgrading can address multiple environmental determinants of health. This paper reviewed urban slum upgrading evaluations from cities across Asia, Africa and Latin America and found that few captured the multiple health benefits of upgrading. With the Sustainable Development Goals (SDGs) focused on improving well-being for billions of city-dwellers, slum upgrading should be viewed as a key strategy to promote health, equitable development and reduce climate change vulnerabilities. We conclude with suggestions for how slum upgrading might more explicitly capture its health benefits, such as through the use of health impact assessment (HIA) and adopting an urban health in all policies (HiAP) framework. Urban slum upgrading must be more explicitly designed, implemented and evaluated to capture its multiple global environmental health benefits.
... However, despite the development of a multitude of models and processes, and its increasing application at different policy levels (2)(3)(4), HIA's role within the policy process remains largely 679918P ED0010.1177/1757975916679918Original ArticleG. ...
Article
With the implementation of health impact assessment (HIA)'s conceptual model into real-world policymaking, a number of fundamental issues arise concerning its decision-support function. Rooted in a rational vision of the decision-making process, focus regarding both conceptualisation and evaluation has been mainly on the function of instrumental policy-learning. However, in the field of social health inequalities, this function is strongly limited by the intrinsic 'wickedness' of the policy issue. Focusing almost exclusively on this instrumental function, the real influence HIA can have on policymaking in the longer term is underestimated and remains largely unexploited. Drawing insights from theoretical models developed in the field of political science and sociology, we explore the different decision-support functions HIA can fulfill and identify conceptual learning as potentially the most important. Accordingly, dominant focus on the technical engineering function, where knowledge is provided in order to 'rationalise' the policy process and to tackle 'tame' problems, should be complemented with an analysis of the conditions for conceptual learning, where knowledge introduces new information and perspectives and, as such, contributes in the longer term to a paradigm change.
... Based on the recognition that population health is impacted by individual-level factors as well as broader determinants of health including environmental, institutional and/or economic factors (18,22), HIA aims to address health inequalities by drawing attention to the impacts of health sector-and non-health sector-related activities on population health, and advocating for the inclusion of health in decision-making (19,21,23,24). The benefits of HIA do not end at the decisionmaking level; HIA can be an emancipatory tool for health promotion (25,26). ...
Article
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Electronic waste (e-waste) is a growing health and environmental concern in developing countries. In the sub-Saharan African region e-waste is considered a crisis with no end in sight yet; there is lack of structures and regulations to manage the problem. In this article, we discuss the potential of Health Impact Assessment (HIA) in addressing the health, environmental, and social impacts of e-waste in sub-Saharan Africa. We draw from environmental policy, environmental communication, global health policy, and health communication to argue that managing e-waste could be framed as ongoing HIA where all the steps of HIA are performed on a rolling basis with input from local communities. Further, we suggest that HIA should be infused into recycling legislation to help streamline the practice in order to make it safe for health and the environment and to maximize the economic benefits.
... Such HIAs are known as 'participatory HIAs' (Mahoney et al. 2007 ). Another type, 'community-led' HIAs give a community ownership of the process and fi nal decisionmaking with technical support (Mahoney et al. 2007 ;Harris-Roxas and Harris 2011 ). We examine how public participation and NF are linked via community input as a form of data, via participation itself and through the outcomes of an HIA. ...
Chapter
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The characterisation of individual Subjective Well-being (SWB) is increasingly robust, whereas social SWB at neighbourhood-level is not. We propose a preliminary framework for neighbourhood flourishing: strong SWB among neighbourhood residents. Urban design may positively affect neighbourhood flourishing. We demonstrate the utility of the framework in designing neighbourhoods via participatory case studies, using two approaches: Health Impact Assessment (HIA) and Extreme and Participatory Citizen Science (EPaCS). We show promising links between residents’ participation, urban design factors and neighbourhood flourishing outcomes. Our cases reveal resources, problems, and solutions not necessarily uncovered by technical ‘experts’, increasing the likelihood of supporting neighbourhood flourishing. We conclude that EPaCS and HIA have potential for the application of our framework. Neighbourhood flourishing may be a key yardstick by which urban environments and participatory processes should be judged. We recommend that the framework and its application be developed further via collaboration between academics, policy-makers, practitioners and communities.
... For example, Sala et al. (2015) refer to the 'sustainability assessment procedure' as comprising "several steps"; or Binder et al. (2010) notes the 'structure of the procedure' being composed of a phase and steps. This reference to a "procedural framework" being focused on the key steps is evident in other impact assessment literature, such as from Strategic Environmental Assessment (SEA) (Chaker et al., 2006), Environmental Impact Assessment (EIA) (Momtaz, 2002), Social Impact Assessment (SIA) (Arce-Gomez et al., 2015), and Health Impact Assessment (HIAs) (Harris-Roxas and Harris, 2011). This perspective is warranted for a number of reasons, not least of which, is the recognition that there is a lack of "commonly understood process for conducting them [sustainability assessments]" (Pope et al., 2017, p205). ...
Article
Sustainability assessment is a key method that offers a platform from which the private sector can implement systematic processes to address sustainability. While this presents a unique opportunity for broadening the use of sustainability assessments, this is constrained by the lack of commonly accepted processes and little empirical evidence on private sector practices. This study directly engages with this dilemma, examining the initiation step of the sustainability assessment from a procedural framework perspective. A multiple case study approach is utilised with semi-structured interviews of 32 respondents from nine multinational enterprises operating in the manufacturing industry of Indonesia. Findings indicate the initiation step is initially directed by regulatory compliance, with organisations using checklists based on mandatory sustainability issues to consider. The majority of organisations go beyond this compliance approach, however, with the role of the headquarters directing these organisations to more holistically consider sustainability issues through the use of established lists and materiality analysis. This is informed through headquarter commitments to voluntary international standards and global sustainability guidelines, which have translated into corporate practice through established policies and procedures. These findings highlight the importance of an emerging trend for the private sector to undertake voluntary activities beyond the regulatory context of the country they are operating within, and guided by corporate codes of conduct, when undertaking sustainability assessments.
... For example, Sala et al. (2015) refer to the 'sustainability assessment procedure' as comprising "several steps"; or Binder et al. (2010) notes the 'structure of the procedure' being composed of a phase and steps. This reference to a "procedural framework" being focused on the key steps is evident in other impact assessment literature, such as from Strategic Environmental Assessment (SEA) (Chaker et al., 2006), Environmental Impact Assessment (EIA) (Momtaz, 2002), Social Impact Assessment (SIA) (Arce-Gomez et al., 2015), and Health Impact Assessment (HIAs) (Harris-Roxas and Harris, 2011). This perspective is warranted for a number of reasons, not least of which, is the recognition that there is a lack of "commonly understood process for conducting them [sustainability assessments]" (Pope et al., 2017, p205). ...
Article
Over recent decades, there has been a significant proliferation of types of impact assessments. While some argue that this is threatening future use of impact assessments, sustainability assessments have emerged as a potential approach to bridge these diverse approaches. This research focuses on examining sustainability assessments at the project level, looking specifically at scoping practices key to integration. Nine multinational enterprises operating within Indonesia are studied, utilising a case study methodology with semi-structured interviews with 32 respondents. Findings emphasise that while these multinationals sought to address key regulatory requirements through their scoping practices, international standards and global sustainability platforms were critical in informing the practices of these organisations. The recognition of these standards and guidelines saw them addressing a broad range of key sustainability issues; also using prescribed techniques to engage with stakeholders and identify the most critical sustainability issues to focus on in assessment. There was integration of scoping processes through different levels and across the organisations, which were generally managed by teams providing sustainability expertise, including through affiliate personnel for local contextualisation. Abbreviation AMDAL - Analisis Mengenai Dampak Lingkungan (EIA); BAPEDALDA - provincial/regional-level of the Environmental Impact Management Agency; CAQDAS – computer assisted data analysis software; CSR – corporate social responsibility; EIA – environmental impact assessment; EU – European Union; FDI – foreign direct investment; GRI – Global Reporting Initiative; ILO – International Labour Organization; MCA – multicriteria analysis; MNE – multinational enterprise; MOE - Ministry of Environment (now Ministry of Environment and Forestry); NGO – non-government organisation; OECD – Organisation for Economic Cooperation and Development; OH&S – occupational health and safety; SPPL - Letter of Statement on Environmental Management Effort; UKL – Environmental Management Effort; UN – United Nations; UNGC – United Nations Global Compact; UPL - Environmental Controlling Effort.
... Over the past two decades, the use of health impact assessment (HIA) has grown rapidly (Harris-Roxas et al. 2012) and this is most likely attributable to the increased combined efforts of the three complementary areas of policy concern and activity: environmental health, the wider determinants of health and health equity, all of which are integral components in HIAs (Harris-Roxas and Harris 2011;Harris-Roxas et al. 2012). The fundamentals of HIAs are concerned with how the health and well-being of a population could be affected by a proposed policy, plan or action and the widely accepted key definition of HIA is that of the Gothenburg Consensus (WHO 1999), which describes HIA as 'a combination of procedures, methods and tools by which a policy, programme or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population'. ...
... This model includes three variables: S, I, and R, representing the number of susceptible people, infected people, and recovered people, respectively at specific timesteps. In addition to considering epidemiological models and policy factors, there are many other types of pandemic-effective factors, such as public-health factors (including the social and economic environment, human characteristics and behaviors, social activities, and transportation patterns) [40] and environmental factors (including temperature, humidity, and air quality) [41,42]. ...
Preprint
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The sudden outbreak of the Coronavirus disease (COVID-19) swept across the world in early 2020, triggering the lockdowns of several billion people across many countries, including China, Spain, India, the U.K., Italy, France, Germany, and most states of the U.S. The transmission of the virus accelerated rapidly with the most confirmed cases in the U.S., and New York City became an epicenter of the pandemic by the end of March. In response to this national and global emergency, the NSF Spatiotemporal Innovation Center brought together a taskforce of international researchers and assembled implemented strategies to rapidly respond to this crisis, for supporting research, saving lives, and protecting the health of global citizens. This perspective paper presents our collective view on the global health emergency and our effort in collecting, analyzing, and sharing relevant data on global policy and government responses, geospatial indicators of the outbreak and evolving forecasts; in developing research capabilities and mitigation measures with global scientists, promoting collaborative research on outbreak dynamics, and reflecting on the dynamic responses from human societies.
... L'OMS a permis l'émergence de la démarche et l'a inscrite au début des années 2000 dans le programme du Réseau européen des Villes-Santé [30]. L'EIS s'est développée à travers le monde avec une grande diversité dans les pratiques [31,32]. Elle est aujourd'hui présente dans tous les continents, avec des degrés d'institutionnalisation variables, parfois autonome, parfois intégrée à d'autres évaluations d'impact [20]. ...
... Examples of HIA tools applicable to BE are the AirQ + tool [21], HEAT tool [22], the Integrated Transport and Health Impact Modelling Tool (ITHIM) [23] and the UTOPHIA tool [24]. HIA can be categorized as quantitative, qualitative, or participatory, based on the datasets and methods used [25,26]. Quantitative HIAs have been applied to several domains relevant to the built environment [27], including transport [16,28], urban vegetation [29], and land use [30]. ...
Article
Full-text available
Purpose of Review Features and attributes of the built environment (BE) impact positively and negatively on health, especially in cities facing unprecedented urban population growth and mass motorization. A common approach to assess the health impacts of built environment is health impact assessment (HIA), but it is rarely used in low- and middle-income countries (LMICs) where urbanization rates are fastest. This article reviews selected HIA case studies from LMICs and reports the methods and tools used to support further implementation of quantitative HIAs in cities of LMICs. Recent Findings In total, 24 studies were reviewed across Algeria, Brazil, China, India, Iran, Kenya, Thailand, Turkey, and Mauritius. HIAs examine specific pathways through which the built environment acts: air pollution, noise, physical activity, and traffic injury. Few HIAs of BE addressed more than one exposure pathway at a time, and most studies focused on air pollution across the sectors of transport and energy. A wide number of tools were used to conduct exposure assessment, and different models were applied to assess health impacts of different exposures. Those HIAs rely on availability of local concentration data and often use models that have set exposure–response functions (ERFs). ERFs were not adapted to local populations except for HIAs conducted in China. Summary HIAs of BE are being successfully conducted in LMICs with a variety of tools and datasets. Scaling and expanding quantitative health impact modeling in LMICs will require further study on data availability, adapted models/tools, low technical capacity, and low policy demand for evidence from modeling studies. As case studies with successful use of evidence from modeling emerge, the uptake of health impact modeling of BE is likely to increase in favor of people and planet.
... HEALTHY WORKSPACES tions of the urban settlement are advantageous in terms of healthy architecture as the ones in a tight setting with dense population have to deal with more problems in the first phases of design. Regarding further strategies of architecture to provide healthy environments in building scale, various research have been conducted [9][10][11]. These strategies mostly match with the principles of sustainable and energy efficient design. ...
Article
Indoor environmental quality is a requirement for good architectural and interior design. The definition of indoor environmental quality refers to the conditions of the interior space that provide health and wellbeing for its occupants. Elements of indoor environmental quality are thermal comfort, indoor air quality, ventilation, ergonomics, natural and artificial lighting, odor, and acoustic quality. Indoor environmental quality is required in every type of interior space including ones with residential, educational, and cultural functions and workspaces. It is also included as one of the factors of energy efficient and sustainable design in building energy certification and accreditation systems. This study focuses on call center interiors as a type of workspaces, where the employees spend a long time in the interior space communicating with customers on the phone. The aim is to provide theoretical information and practical application suggestions for higher quality design in call center interiors. The methodology of this paper consists firstly of a literature review to study and analyze the definition and elements of indoor environmental quality, and its implementation into call center interiors as workspaces. Analytical studies lead to strategy proposals for better designed call center interior spaces. The results of the study indicate that better designed interior spaces in call centers lead to better health and wellbeing of the employees, resulting with higher performance and service quality.
... HIA is a flexible tool supporting decision making that enables the consideration of health in the development of policies, programs, or projects, particularly outside the health sector [12]. It was developed during the 1990s to complement environmental impact assessments and to better take into consideration social and health inequalities [13]. HIA has been defined by the WHO as "a combination of procedures, methods and tools by which a policy, program or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population" [14], and "identifies appropriate actions in order to manage those effects" [15]. ...
Article
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Health impact assessments (HIA) allow evaluation of urban interventions’ potential effects on health and facilitate decision-making in the urban planning process. However, few municipalities have implemented this method in Canada. This paper presents the approach developed with partners, the process, and the outcomes of HIA implementation after seven years of interinstitutional collaborations in Quebec City (ten HIA). Using direct observation and meeting minutes, information includes: perceived role of each institution taking part in HIA beforehand, how the HIA process was implemented, if it was appreciated, and which outcomes were observed. The intersectoral interactions contributed to the development of a common language, which sped up the HIA process over time and fostered positive collaborations in unrelated projects. It was an effective tool to share concerns and responsibilities among independent institutions. This experience resulted in the creation of an informal group of stakeholders from four different institutions that perform HIA to this day in collaboration with researchers.
... We have done so in order to not exclude studies based on the ongoing discussion of what constitutes HIA. Our approach to HIA in this review is consistent with the 'social view on HIA' as proposed by Harris-Roxas and Harris (2011). ...
Article
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Health initiatives are increasingly situated outside the institutionalised public health sector. The intersectoral character of societal initiatives, along with indirect relationships between initiatives and health, makes making projections of reach, impact and goal achievement complex. This scoping review of the peer-reviewed literature searches for appropriate methods to conduct quantitative health impact assessment for such initiatives. Database searches were done in PubMed and Web of Science, as well as a reference list search. Studies were then selected in a systematic manner. The review includes 64 studies. Most studies made estimates using simulation methods, notably with Monte Carlo, Markov and system dynamics modelling. Inputs for the models such as transition probabilities and price elasticities were taken from census, register and survey data, evidence from previous (scientific) studies and sometimes outcomes from stakeholder participation. Of different health outcome measures, the number of deaths was most frequently used, followed by QALYs and DALYs and life years. Health effect distribution is frequently mentioned, but not often estimated. Scientific methodological publications on HIAs focusing on civil society initiatives are relatively sparse, indicating possibilities for further methodological advancement. Estimating health effect distributions and incorporating stakeholder participation could make meaningful additions to standard practice.
... During the 1970s, the social impact assessment (SIA) approach was established, placing particular emphasis on the interrelations between the environmental and social impacts, including health [1,3]. With the aim to more specifically address potential impacts of projects, programs, plans and policies on human health as a stand-alone process, health impact assessment (HIA) was introduced in the late 1980s/early 1990s [2,[4][5][6]. Over the past 30 years, the methodology and approach for assessing health impacts has been further developed [7]. ...
Article
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Natural resource extraction projects, including those in the mining sector, have various effects on human health and wellbeing, with communities in resource-rich areas in sub-Saharan Africa (SSA) being particularly vulnerable. While impact assessments (IA) can predict and mitigate negative effects, it is unclear whether and to what extent health aspects are included in current IA practice in SSA. For collecting IA reports, we contacted 569 mining projects and 35 ministries regulating the mining sector. The reports obtained were complemented by reports identified in prior research. The examination of the final sample of 44 IA reports revealed a heavy focus on environmental health determinants and included health outcomes were often limited to a few aspects, such as HIV, malaria and injuries. The miniscule yield of reports (1.6% of contacted projects) and the low response rate by the contacted mining companies (18%) might indicate a lack of transparency in the IA process of the mining sector in SSA. To address the shortcomings identified, policies regulating IA practice should strengthen the requirements for public disclosure of IA reports and promote a more comprehensive inclusion of health in IA, be it through stand-alone health impact assessment or more rigorous integration of health in other forms of IA.
... In addition to considering epidemiological models and policy factors, there are many other types of pandemic-effective factors, such as public-health factors (including the social and economic environment, human characteristics and behaviors, social activities, and transportation patterns) [40] and environmental factors (including temperature, humidity, and air quality) [41,42]. ...
Article
Full-text available
The sudden outbreak of the Coronavirus disease (COVID-19) swept across the world in early 2020, triggering the lockdowns of several billion people across many countries, and most states of the U.S. The transmission of the virus accelerated rapidly with the most confirmed cases in the U.S., and New York City became an epicenter of the pandemic by the end of March. In response to this national and global emergency, the NSF Spatiotemporal Innovation Center brought together a taskforce of international researchers and assembled implementation strategies to rapidly respond to this crisis, for supporting research, saving lives, and protecting the health of global citizens. This perspective paper presents our collective view on the global health emergency and our effort in collecting, analyzing, and sharing relevant data on global policy and government responses, geospatial indicators of the outbreak and evolving forecasts; in developing research capabilities and mitigation measures with global scientists, promoting collaborative research on outbreak dynamics, and reflecting on the dynamic responses from human societies.
... urban) development policies and projects on a particular population (Glasson, Therivel & Chadwick, 2013). Many countries worldwide use HIAs to varying degrees to limit the effect of development policies on human health (Harris-Roxas & Harris 2011). The aim of HIA is to enable decision-makers take more informed choices to promote health or limit the spread of disease (Kemm, 2001;Ross, Orenstein & Botchwey, 2014). ...
Article
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Purpose The design of the built environment is a determinant of health. Accordingly, there is an increasing need for greater harmonization of the architectural profession and public health. However, there is a lack of knowledge on whether designers of the built environment are changing their practices to deliver healthier urban habitats. The paper aims to discuss these issues. Design/methodology/approach The research uses a multi-method approach to data analysis, including: systematic mapping study, structured review and thematic analysis. Findings The research finds that there are almost no requirements for the compulsory inclusion of health across institutions and agencies that have the power to execute and mandate the scope of architectural profession, training, education, practice or knowledge. Despite the urgent need for action and the myriad entreatments for greater integration between architecture and health, there is very little evidence progress. Practical implications The research has implications for the architectural profession and architectural education. Health and well-being is not currently an integral part of the educational or professional training requirements for architects. University educational curriculum and Continuing Professional Development criteria need to better integrate health and well-being into their knowledge-base. Social implications The design of the built environment is currently undertaken by an architectural profession that lacks specialized knowledge of health and well-being. There is a risk to society of environments that fail to adequately protect and promote the health and well-being of its inhabitants. Originality/value The research evidences, for the first time, the lack of integration of “health and wellbeing” within the architecture profession training or education systems.
... HIAs can take a number of different forms, depending on the purpose [26]. Some HIAs, for example, explicitly focus on health equity, seeking to disentangle the differential impacts of the trade treaty on vulnerable population groups (e.g. ...
Chapter
This chapter reviews key research methods used to interrogate trade and health relationships organised under seven categories: ‘Big Trade’ studies that rely on large data sets; country case studies which dig deeper into specific trade-related pathways; natural experiments which compare health outcomes between matched countries following new liberalisation measures; health impact assessments which use findings from multiple studies to suggest how trade measures are likely to affect health; economic impact assessments which estimate aggregate welfare gains (income, gross domestic product); qualitative comparative analysis which examines how liberalisation interacts with different public policies to affect health outcomes; and legal research that focuses on specific treaty provisions and dispute panel decisions. The strengths and limitations of each type of study design are discussed with examples from the published literature.
Article
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Participation procedures that do not address existing power relations among actors can preserve or exacerbate injustice and put those already socially marginalised in a more disadvantaged position in environmental management. This paper therefore explores the role of intermediary actors in establishing procedural justice grounds for meaningful participation in environmental impact assessments (EIAs). It also examines the extent to which Indonesia’s EIA supports legitimate and accountable representation by NGO intermediaries, thereby helping to achieve procedural justice in the practice of EIA. The findings highlight the procedural justice goals that are discernible through Indonesia’s EIA regulatory framework. Three EIA commissions and two village case studies exhibit different interpretations of the meaning and implications of legitimacy regarding representation by NGOs in the EIA decisionmaking process. In the case studies, instances of land-use conflicts demonstrated concerns over NGO’s accountability, resulting in the perception of “unjust” participation by the research participants. This paper suggests that more attention should be paid to conceptualising the value and implications of accountability and legitimacy, which will support the representation of intermediaries in EIA and create a more meaningful and just public participation process.
Book
The need for policy coherence between trade and health has never been greater, yet few public health workers are equipped to navigate this complex field. This book aims to fill this gap, providing a focused and readable introduction to the topic. It introduces the principles underpinning trade treaties and examines the implications of trade rules for health services and access to medicines, unhealthy commodities, labour rights and the environment. It explores the trade policy making process, methods for trade and health research, and recommendations for strengthening policy coherence.
Technical Report
Health is routinely considered in strategic environmental assessment (SEA) and environmental impact assessment (EIA), following requirements of European Union directives and the Protocol on Strategic Environmental Assessment to the Convention on Environmental Impact Assessment in a Transboundary Context (Espoo Convention). Policy-makers and other sources report that these assessments mostly adopt a biophysical perspective and that few cases consider or define health in a manner which is consistent with the WHO Constitution, by considering the wider social, economic, behavioural and institutional aspects of health. This systematically conducted review of over 333 SEA and EIA cases in the WHO European Region shows that while about 80% of assessments pursue a narrow, biophysical interpretation of health, around 10% consider wider determinants when defining health, and another 10% consider wider determinants of health in the actual assessment. Twelve case studies are presented, literature is reviewed and implications for practice are considered.
Article
HIA implementation has rapidly grown in France. The question arises as to whether such growth is paving the way towards institutionalisation. An analytical framework was built based on the literature, capturing key dimensions characterising HIA practice and institutionalisation. Collected data draw upon documented HIAs, evaluation reports, direct observations and workshops. HIA practice in France follows a stand-alone procedure and is based on a holistic model of health. Its largely concerns intermediate HIAs commissioned by municipalities with the support of regional health authorities. Mainly applied to urban planning, HIAs are usually conducted by private firms, and local health observatories. Levers of institutionalisation include: an enduring tradition of intersectoral collaborations for health; a growing culture of health promotion; supportive environmental regulatory requirements; and policy frameworks and mandates addressing health inequalities at a regional and municipal level. For HIA to be more institutionalised, there is a need to clarify its purpose, continue building capacity, promote impact evaluations for evidence on HIA’ potential to advance HiAP and obtain greater commitment from national authorities.
Article
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Climate change has various adverse impacts on public health, ranging from heat-related illness to an increased risk of undernutrition in low-income countries. Health impact assessment (HIA) has been advocated as a valuable tool to systematically identify and quantify the effects of climate change on public health and to inform and evaluate the impact of disease-specific adaptation measures as well as health co-benefits of mitigation measures. We conducted a scoping review to map out peer-reviewed literature on HIA in the context of climate change. Web of Science, Scopus and PubMed were searched without language or time restriction. Publications were included in the full text screening that presented or discussed the application of HIA for investigating health impacts of climate change, or associated adaptation and mitigation measures. In total, 76 peer-reviewed publications from 26 countries were included and characterized. There was a paucity of studies on HIA in the context of climate change from low- and middle-income countries. The most investigated climate change effects were related to temperature and air-pollution. Consequently, associated health impacts, such as respiratory or cardiovascular morbidity and mortality, were examined most frequently. Research-driven HIAs with a quantitative methodological approach were the predominant choice to assess health impacts of climate change. Only one in five publications applied a classical step-by-step HIA approach. While quantitative assessment of health impacts associated with climate change seems to be a well established field of research, the few publications applying a step-by-step HIA approach to systematically anticipate potential health impacts of climate change in a given context point at a missed opportunity for strengthening intersectoral collaboration to maximize health (co-) benefits of climate mitigation and adaptation measures. To promote the use of step-by-step HIA in regions that are most affected by climate change, HIA teaching and training efforts are urgently needed.
Article
Value judgements in research and political decision-making that exclude evidence for the social determinants of suicide suggest that evidence is not sufficient on its own to guide policy and practice, and that there is a lack of conceptual clarity with regard to decisions relating to the prioritization of problems, the allocation of resources, the translation of research into practice, as well as questions of responsibility for suicide prevention. In this work I seek to broaden conventional ethical debate about suicide through the use of public health ethics frameworks. I argue that despite espousing a public health approach, current suicide prevention strategies are based largely on individual-level theorizing. This emphasis on the individual works to responsibilize individuals and communities for suicide prevention and directs attention away from public policy and systemic inequities. Given continued high rates of suicide, especially among disadvantaged social groups and communities, comprehensive government action is required to address the social and political determinants of suicide. Normative justification for action in realizing these ends is critical. I conclude by proposing one practicable form of action to make values and value judgements in suicide prevention explicit so that alternative forms of ethical and political recognition and responsibility are acknowledged.
Chapter
Eine Gesundheitsfolgenabschätzung (GFA) prüft die Gesundheitsauswirkungen von geplanten Vorhaben in unterschiedlichen Politikfeldern und erarbeitet Empfehlungen, wie diese optimiert werden können. GFA können auf geplanten Vorhaben innerhalb und außerhalb des Gesundheitssektors angewandt werden. GFA ist eine Chance, Health in all Policies zum Leben zu erwecken, und verdient auch in Deutschland mehr Beachtung.
Article
Health Impact Assessments (HIA), promoted by WHO, are generally presented as a process supporting decision-making in favor of health. HIA differs from other forms of policy assessments as it relies on core values among which democracy, equity and sustainable development. It is also characterized by a cross-sectional approach based on the diversity of health determinants that are taken into account. Beyond decision-making, we explored the capacity of the HIA process to generate a collective (social) learning among participants. We questioned its ability to facilitate the emergence of a common culture on health, its determinants, and urban planning. Here we report on our experience of an HIA conducted on a large urban project in the west of Paris. We pursued an open approach allowing municipal agents to actively participate in the process, and learn about the project in general, using health as a new lens for the appraisal. The participants, originating from several departments, were involved in collective working sessions. Their contribution was sought for the elaboration of a set of assessment criteria, linking health determinants with the major issues of sustainable development, then focusing on the assessment of the urban project through a global deliberation. At the end of the HIA process, participants were asked to respond to a survey regarding their opinion on the whole process and the benefits they perceived. Responses seem in support of the relevance of our approach, favoring the participants’ engagement and allowing them to widen their perspectives, beyond their usual field of competences. The HIA process, which included municipal agents, and the discussion that was generated throughout, were perceived as a means to objectivize and federate opinions on issues that are not, or seldom, considered explicitly by urban planners.
Article
Health impact assessments (HIA) allow the potential impact of nonhealth-related actions (policy, project, program) on health to be analyzed. For example, municipal projects, for urban renewal or urban planning, have an impact on health drivers relating to the created environment, and thus, on public health. In the province of Quebec, the government and afliated organizations have to comment on potential impacts; they use HIAs to ensure health is factored into public actions. We know little about HIAs' capacity to in?uence public policies; every policy and program is di?erent and is ofen implemented only once, greatly complicating evaluation. Our goal is to analyze the potential of contribution analysis for evaluating the impact of HIAs at the municipal level. To this end, we present the HIA process as implemented in Montérégie, we identify evaluation challenges, and put forth, through contribution analysis, an evaluation strategy to analyze e?ects. © 2017 Canadian Journal of Program Evaluation/La Revue canadienne d'évaluation de programme.
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Many countries have introduced health impact assessment (HIA) at the national, regional, or local levels. In France and in Québec, there is increasing interest in using HIA to inform decision-makers and influence policies, programs, and projects. This paper aims to compare HIA implementation models in two regions: Nouvelle-Aquitaine (France) and Montérégie (Québec, Canada) using a case study methodology. The objective is to gain a better understanding of the similarities and di�erences in the approaches used to achieve the operationalization of HIA. The methodological approach involves four steps: (1) design of an analytical framework based on the literature; (2) exchanges within the research team and review of documents concerning the two implementation strategies under study; (3) development of the case studies based on the proposed framework; and (4) cross-comparison analysis of the case studies. The findings show that the two regions share certain similarities, including the strong commitment and political will of the public health organizations involved and a well-established culture of engaging in intersectoral action with municipal partners. Di�erences mainly concern their di�erent approaches to implementing HIAs in accordance with the regional policies and the organizational and administrative contexts in place. This study identifies potential avenues for supporting the practice of HIA at the municipal level.
Thesis
La prévalence de la sédentarité ne cesse d’augmenter et de progresser. L’inactivité physique est laquatrième cause de décès évitable: 1.9 millions de décès lui sont attribués dans le monde. Plusieursétudes ont montré l’intérêt et le besoin de promouvoir l’activité physique dans différents milieux.Néanmoins, il reste un grand vide à combler entre la théorie, les politiques et le passage à l’acte.Cette thèse a pour but d’analyser et de développer des outils d’évaluations spécifiques afin d’apporterla preuve de l’utilité des recommandations de promotion d’activité physique et de lutte contre lasédentarité.Notre première étude analyse les données d’un outil de mesure de condition physique en populationgénérale sur un échantillon de 31 133 individus français âgés entre 8 et 60 ans. Nous avons évalué lafiabilité et la reproductibilité de l’outil. Par la suite, nous avons analysé le lien entre l’indice de massecorporelle, l’âge et les performances des différentes dimensions physiologiques mesurées. Les résultatsmontrent une bonne reproductibilité du test et une forte corrélation entre les performances, l’âge etl’indice de masse corporelle. Ceci suggère que l’outil pourrait servir comme instrumentépidémiologique pour évaluer l’efficacité des interventions de promotion d’activité physique.Notre deuxième étude évalue une intervention de remise en forme pour des salariés souffrant dedouleur lombaire chronique en collaboration avec leur service de médecine de travail. Les mesuresd’accompagnement ajustent l’activité physique sur le lieu même de l’entreprise. L’échantillon estconstitué de 37 sujets qui ont suivi des séances d’exercices trois fois par semaine pendant 2 mois et de38 sujets dans le groupe témoin. Les paramètres physiques, psychologiques, sanitaires et sociaux ontété analysés en trois temps (début, 2 mois et 6 mois). Suite à cette intervention, nous avons observéchez le groupe expérimental une amélioration significative des paramètres physiques, psychologiqueset sanitaires, qui persiste à 6 mois. Cette étude renforce donc la promotion d’activité physique enmilieu de travail afin de mieux accompagner les sujets à risques de troubles musculo – squelettiques.Notre troisième étude porte sur les méthodes de promotion d’activité physique à travers les transportsactifs en milieu urbain. Nos travaux sont reliés aux outils d’évaluation d’impact sanitaire suite à unreport modal de transport. Cette étude est réalisée en collaboration avec le CREAL (Center forResearch in Environmental Epidemiology) à Barcelone et six grandes villes européennes. Elle proposedes méthodes de mesure de la dépense énergétique en fonction du mode, associant ces indicateurs àleur gain sanitaire.En conclusion cette thèse fournit une nouvelle méthodologie d’approche ainsi que des outilsd’évaluation spécifiques qui pourront aider à promouvoir la prévention par l’activité physique.
Thesis
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Health Impact Assessment (HIA) is a decision-making support tool to judge a policy as to its potential effects and its distribution on a population’s health (equity). It’s still very often a qualitative approach.The main aim here is to show the usefulness of applying quantified multivariate statistical methodologies to enrich HIA practice, while making the decision-making process easier, by issuing understandable outputs even for non-statisticians.The future of healthcare reforms shifts the center of evaluation of health systems from providers to people’s individual needs and preferences, reducing health inequities in access and health outcomes, using big data linking information from providers to social and economic health determinants. Innovative statistical and assessment methodologies are needed to make this transformation.Data mining and data science methods, however complex, may lead to graphical outputs simple to understand by decision makers. HIA is thus a valuable tool to assure public policies are indeed evaluated while considering health determinants and equity and bringing citizens to the center of the decision-making process.
Thesis
Cette recherche porte sur l'évaluation de la durabilité en phase amont d'un projet architectural. Cette thèse argumente la nécessité d'évaluer l'impact sur les aspects de développement durable en phase de préconception. La phase amont est très importante en raison de son faible coût et des degrés de liberté qu'elle permet lors des prises de décisions. Ainsi l'élaboration d'un outil ou d'un modèle pouvant aider les architectes à identifier les potentiels de durabilité en préconception, représente un enjeu important pour l'aide à la décision architecturale. En prenant en compte les impacts de la durabilité en phase amont, le concepteur peut s'astreindre à une vision différente et peut aborder des espaces de solutions visant à augmenter le niveau de durabilité de son projet. La méthode de conception à objectif désigné (COD) est utilisée en tant que démarche pour structurer l'outil d'aide à la décision. Cet outil aide les architectes à guider leur choix en fonction d'objectifs pré-établis. De plus, grâce à la COD, tous les acteurs du domaine de la construction peuvent participer à la phase de la programmation. D'autre part, l'accent peut être mis sur l'aspect socioculturel que les méthodes existantes ont négligé. Notre outil a été développé sous forme de logiciel puis a été expérimenté sur quatre projets réels en Iran. Les résultats bruts attestent de la pertinence de l'outil en phase de préconception
Article
Background With the objective to avoid and mitigate potential adverse health impacts of projects, programmes and policies, health impact assessment (HIA) offers an opportunity for disease prevention and health promotion. Although HIA has gained importance over the past two decades, it is unclear whether and to what extent HIA practice has been established and institutionalised in Latin America. To address this issue, the current practice and prospects of HIA in Latin America was assessed in the peer-reviewed literature and existing guidelines. Methodology The peer-reviewed literature was systematically searched using five electronic databases until February 2016. Studies were included on a set of pre-defined criteria. The search was carried out in English, French, Portuguese and Spanish. Additionally, a search for HIA guidelines used in Latin American countries and territories was performed by means of a Google search and on websites of government departments and institutions that may promote HIA. Results The search yielded 167 hits in the peer-reviewed literature of which 17 articles met inclusion criteria. Only four peer-reviewed articles described prospective HIAs and four featured a discussion of the HIA approach. The remaining nine articles presented health impact evaluations. Most studies were published only recently, after 2012 (88%). Seven HIA guideline documents were identified, two of which were country-specific (i.e. Brazil and Mexico) and the remaining five addressed HIA at the regional level. Conclusions This study confirmed the paucity of literature pertaining to HIA implementation, as well as HIA guidelines in Latin America. Mexico, Brazil and Cuba have the longest track record in scientific literature and guidelines on HIA. In order to better understand current barriers and limitations to practice and institutionalisation of HIA in Latin American countries, a broad discussion among policy makers, academic institutions and HIA practitioners is warranted nationally and regionally.
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Early textbook (1995) on Health Impact Assessment with lots of examples from development projects. Readers are advised to see the new textbook: Health Impact Assessment: principles and practice (2011) also in Chinese.
Article
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Public health issues, such as obesity, lung disease from air pollution or mental health complaints from living in an unsafe neighbourhood, are complex, intractable policy problems. The causes are dispersed at the individual and the collective level among different societal sectors. One strategy to integrate health in other sectors’ policies for developing effective and cooperative policy solutions is to provide evidence in a Health Impact Assessment (HIA) from proposed policies and project plans. In 15 years of practising HIA, policymakers and academics nevertheless express concern about its effectiveness. In The Politics of Healthy Policies a conceptual and empirical analysis is presented of the role of HIA in policy development. From a governance perspective the author identifies different purposes of HIA for indicating societal problems and democratic deficits. These suggest that a technical design of HIA to assess causes and effects insufficiently addresses the political and normative issues of collaborative policymaking without institutional requirements or incentives. Four case studies are analysed of Dutch HIA practices at the national and local policy level, including a game simulation of health advocacy without HIA. The outcomes suggest that a re- orientation on HIA is necessary in order to mobilise other sectors to prevent or mitigate public health problems. The author proposes an interaction-oriented, reflective design and a new definition of HIA. The book is especially relevant to HIA practitioners and health policymakers at different governmental levels. Many of the implications are highly relevant to other forms of impact assessment as well.
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This paper reviews the development of health impact assessment (HIA) in New Zealand to reveal factors which inhibited its effective institutionalisation until recently. It considers how differing views of HIA have affected the institutionalisation process, and assesses the longer-term prospects for HIA in policy- and project-level assessments. There is lack of a clear statutory mandate for considering health impacts under the Resource Management Act, although HIA and closely related health risk assessments have been carried out under other legislation, including the Biosecurity Act. Consequently, different understandings of the nature and purpose of HIA have developed, associated with different practitioner communities, often operating in isolation from other practitioners and the wider impact assessment community. The renewed effort to mobilise HIA has emphasised policy-level application in central government; the Ministry for Health now has an HIA Unit, and statutory recognition of the process is promised in the new Public Health Act.
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This review package is intended to enable a commissioner or reviewer of an HIA report to reach an opinion as to the quality of the completed report in a simple, quick and systematic manner. There are many guides that assist practitioners to conduct HIA. HIA reports are completed without reference to one particular standard against which commissioners, or others, may review the quality of the completed HIA report. International best practice standards exist as guidance principles on conducting and reporting HIA. However, these standards do not provide guidance on reviewing the reports of HIAs which are conducted at project level to ensure that the reports are fit for purpose and comply with best practice. To address this omission, in this review package we provide criteria for considering the quality of completed HIA reports. This review package focuses on HIAs prepared in the context of an application for development consent.
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Assessing the health impact of policy outside the health sector is a key part of public health policy making. Policy makers use health impact assessment to improve, promote and protect the health of populations. This paper defines health impact assessment and provides justification for the use of formal health impact assessment tools. The New Zealand policy-making process and the mechanisms currently used within the public sector to assess health impact in New Zealand are discussed. Examples in the public domain from recent public policy making are used to illustrate the discussion. The paper then examines the opportunities that exist for public sector public health policy advisers assessing the health impact of policy in other sectors, given that policy can be a fiercely contested domain, and considers why the generic mechanisms are insufficient to achieve optimal influence. The supports needed for the successful application of formal tools, and the obstacles that exist, are analysed.
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The social determinants of health refer to social, economic and environmental factors that influence well-being including economic inequality, residential segregation, sub-standard housing, lack of supermarkets, schools, transit and open-space, and disruptions to family and social networks. This paper asks whether and how the practice of health impact assessment (HIA) can integrate the social and physical determinants of health into planning processes, overcome institutional and analytic barriers for health analyses in environmental impact assessment, and offer a new model for healthy urban planning. This is done by examining how a municipal health agency, the San Francisco Department of Public Health, utilized HIA to conduct health analyses of development projects, collaborate with other city agencies and community groups, and initiate a multi-stakeholder prescriptive HIA all aimed at integrating health into environmental planning practices. This case is important because the San Francisco DPH is the first city agency in the US to experiment with using HIA that aims to capture the physical and social environmental health impacts of projects and plans. The paper finds that HIA can inject the social determinants of health into planning when public agencies embrace an expanded definition of environmental health, organize health advocacy networks within and outside government, and generate a broad scientific evidence base to substantiate policy change.
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Objectives The National Environmental Policy Act and related state laws require many public agencies to analyze and disclose potentially significant environmental effects of agency actions, including effects on human health. In this paper we review the purpose and procedures of environmental impact assessment (EIA), existing regulatory requirements for health effects analysis, and potential barriers to and opportunities for improving integration of human health concerns within the EIA process. Data sources We use statutes, regulations, guidelines, court opinions, and empirical research on EIA along with recent case examples of integrated health impact assessment (HIA)/EIA at both the state and federal level. Data synthesis We extract lessons and recommendations for integrated HIA/EIA practice from both existing practices as well as case studies. Conclusions The case studies demonstrate the adequacy, scope, and power of existing statutory requirements for health analysis within EIA. The following support the success of integrated HIA/EIA: a proponent recognizing EIA as an available regulatory strategy for public health; the openness of the agency conducting the EIA; involvement of public health institutions; and complementary objectives among community stakeholders and health practitioners. We recommend greater collaboration among institutions responsible for EIA, public health institutions, and affected stakeholders along with guidance, resources, and training for integrated HIA/EIA practice.
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despite health impact assessment (HIA) being increasingly widely used internationally, fundamental questions about its impact on decision-making, implementation and practices remain. In 2005 a collaboration between public health and local government authorities performed an HIA on the Christchurch Urban Development Strategy Options paper in New Zealand. The findings of this were incorporated into the Greater Christchurch Urban Development Strategy. using multiple qualitative methodologies including key informant interviews, focus groups and questionnaires, this study performs process and impact evaluations of the Christchurch HIA including evaluation of costs and resource use. the evaluation found that the HIA had demonstrable direct impacts on planning and implementation of the final Urban Development Strategy as well as indirect impacts on understandings and ways of working within and between organisations. It also points out future directions and ways of working in this successful collaboration between public health and local government authorities. It summarises the modest resource use and discusses the important role HIA can play in urban planning with intersectoral collaboration and enhanced relationships as both catalysts and outcomes of the HIA process. as one of the few evaluations of HIA that have been published to date, this paper makes a substantial contribution to the literature on the impact, utility and effectiveness of HIA.
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A prospective health impact assessment (HIA) was conducted to identify potential health impacts arising from the planned redevelopment of Liverpool Hospital, a major teaching hospital in New South Wales, Australia. A multidisciplinary team of health professionals oversaw the HIA and a core project team led by population health practitioners conducted the HIA using a structured, stepwise process. Methods used to gather data for the identification of impacts were a literature review, development of a population profile and consultation with stakeholders. A range of positive and negative health impacts were identified and an assessment matrix was used to prioritise the health impacts and develop recommendations for the proponents of the redevelopment plan. The HIA added value to the planning process for the hospital redevelopment, increasing capacity to conduct future HIAs.
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The People Assessing Their Health (PATH) Project was designed to provide a means for people in selected communities within Eastern Nova Scotia to become more involved in decision making within the province's emerging decentralized health system. Using community health impact assessment (CHIA) as a population health strategy, community members were able to identify factors that determine their health and to develop tools to help them assess the health impact of programs and policies within their communities. The participatory process used throughout the PATH Project enabled a wide range of people to generate information for designing a community health impact assessment tool (CHIAT) unique to their community. It also helped participants to broaden their understanding of the many factors determining health of their community and of the region.
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Health impact assessment (HIA) aims to make the health consequences of decisions explicit. Decision-makers need to know that the conclusions of HIA are robust. Quantified estimates of potential health impacts may be more influential but there are a number of concerns. First, not everything that can be quantified is important. Second, not everything that is being quantified at present should be, if this cannot be done robustly. Finally, not everything that is important can be quantified: rigorous qualitative HIA will still be needed for a thorough assessment. This paper presents the first published attempt to provide practical guidance on what is required to perform robust, quantitative HIA. Initial steps include profiling the affected populations, obtaining evidence for postulated impacts, and determining how differences in subgroups' exposures and susceptibilities affect impacts. Using epidemiological evidence for HIA is different from carrying out a new study. Key steps in quantifying impacts are mapping the causal pathway, selecting appropriate outcome measures and selecting or developing a statistical model. Evidence from different sources is needed. For many health impacts, evidence of an effect may be scarce and estimates of the size and nature of the relationship may be inadequate. Assumptions and uncertainties must therefore be explicit. Modelled data can sometimes be tested against empirical data but sensitivity analyses are crucial. When scientific problems occur, discontinuing the study is not an option, as HIA is usually intended to inform real decisions. Both qualitative and quantitative elements of HIA must be performed robustly to be of value.
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"An important, controversial account ... of the way in which man's use of poisons to control insect pests and unwanted vegetation is changing the balance of nature." Booklist.
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Environmental health impact assessment is described as an integral part of environmental impact studies. As such, it must be included in the planning of engineering projects. A methodological approach is presented which involves four steps: (1) Identification of the initial pertubations in the environment; (2) tracing pertubations through the environment to determine the magnitude and duration of the exposure to the receptor population; (3) identification of the receptor population and its high risk subgroups; and (4) estimation of these impacts by applying derived exposure response functions.
Article
Health impact assessment (HIA) seeks to expand evaluation of policy and programmes in all sectors, both private and public, to include their impact on population health. While the idea that the public’s health is affected by a broad array of social and economic policies is not new and dates back well over two centuries, what is new is the notion—increasingly adopted by major health institutions, such as the World Health Organisation (WHO) and the United Kingdom National Health Services (NHS)—that health should be an explicit consideration when evaluating all public policies. In this article, it is argued that while HIA has the potential to enhance recognition of societal determinants of health and of intersectoral responsibility for health, its pitfalls warrant critical attention. Greater clarity is required regarding criteria for initiating, conducting, and completing HIA, including rules pertaining to decision making, enforcement, compliance, plus paying for their conduct. Critical debate over the promise, process, and pitfalls of HIA needs to be informed by multiple disciplines and perspectives from diverse people and regions of the world.
Article
of Epidemiology and Community 2003;57:659-662 ME, Sclar E. A joint planning and public framework: contributions to
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Article
The NSW Health and Equity Statement recommended that processes be developed for undertaking both rapid health impact appraisals and comprehensive health impact assessments (HIAs) of new government policy initiatives. The goal was to develop a range of standardised approaches that could be used to assess proposed initiatives for their potential to redress health inequities.
Article
A Health Impact Assessment (HIA) is defined as a combination of procedures, methods and tools by which a policy, programme or project may be judged as to its potential effects on the health of a population and the distribution of these effects in that population. It has the objective to deliver evidence based recommendations to maximise potential positive health benefits and prevent or mitigate any detrimental health impacts that a project may have on any potentially impacted communities. While the concept of Health Impact Assessments is relativity well defined for policy, it is still a relatively new field for assessing the impacts of development projects. Unlike the process of environmental and social impact assessments that are well regulated, but that have a very narrow view of the health impacts, there is no legal requirement for a formal more in depth health impact assessment. However, many companies are adopting the HIA process and as a minimum standard, and it is increasingly required for the external financing of projects. It is thus essential to understand the concept of a HIA. The procedures and methods of a HIA are generally well defined, but the objectives and deliverables are often not that well understood by the project proponents that commission these assessments. Thus; it is essential that the first stages of the assessment procedures are conducted in a meticulous fashion, as the design of the assessment will reflect the final result. This may require initial training in the concept of HIA and what it does and does not deliver.
Article
Increasing emphasis has been placed in recent years on development of the theory of Environmental Impact Assessment (EIA), primarily as a consequence of increasing recognition that the theoretical basis of ‘state-of-the-art’ EIA is inadequately developed and detailed. This study reviews consideration given in the research literature to the role of science in EIA in order to identify implicit theories. It is suggested that there are two main interpretations of the role of science in EIA (EIA as applied science and EIA as civic science) and five distinct models are identified within these paradigms. These models appear to be based predominantly on existing philosophies of science (such as positivism or relativism) and simplistic and ill-defined conceptions of the purposes of EIA. A broad model is proposed for the advancement of theory regarding the role of science in EIA which emphasises conceptual consideration and empirical investigation of the purposes, and hence outcomes, of EIA and the causal processes utilised to achieve these purposes. The model necessitates a reorientation of the research agenda, away from process and procedure to focus on substantive purposes, and this will require more integrative and connective research than has been commonplace in the past. The EIA research agenda must evolve and mature if this globally significant decision tool is to fulfil its potential.
Article
Health impact assessment (HIA) of projects, programmes and policies is increasingly recognized as a powerful methodology for mitigating negative health impacts and enhancing equitable and sustainable development, yet applications in the developing world are sparse. Here, we focus on a large infrastructure development in sub-Saharan Africa, namely the Chad–Cameroon petroleum development and pipeline project. We adapted a five-step process for HIA, consisting of (1) screening of project documents, (2) profiling of affected communities, (3) identifying priority health areas, predicting potential impacts, and proposing mitigation measures, (4) implementing interventions, and (5) monitoring and evaluation of health impacts. We found that project scoping was broad, including extensive environmental and social assessments. Innovative features of the project include the high degree of public–private partnerships, and the management of oil revenues for purposes of poverty reduction. The project also addressed occupational and public health issues, and developed and implemented measures to prevent or mitigate potential health impacts. However, there was a disproportionate emphasis on workers' health, particularly on the prevention/mitigation of construction-related injuries, sexually transmitted infections (STIs; mainly HIV/AIDS), and malaria. Health impacts among surrounding communities, and cumulative health impacts in the larger region were not considered in a comprehensive way. Concluding, there is a need for a more systemic approach to HIA and its incorporation within ‘Equator Principles’, which are increasingly adopted by the international financial community. This process would include clarification of corporate social responsibility beyond the project fence line in the mitigation of health problems at regional levels. Finally, we propose the establishment and running of a longitudinal demographic surveillance system, which—coupled with regular household surveys—would facilitate monitoring and evaluation of impacts on health, social wellbeing and equity in the broadest possible manner.
Article
Core HIA documents, researchers and practitioners assert the significance of community participation in health impact assessment. Despite the rhetoric, there has been little critical examination of the role of community participation in HIA. Knowledge and debate regarding what constitutes community participation and how it may best be achieved is often confused and opinion is divided as to its usefulness and appropriateness for HIA. This paper does not seek to argue the merits or drawbacks of community participation; rather, the authors explore the origins and character of the current discord around public participation in HIA and provide a lexicon for moving practice and discussion forward. The authors argue that the origins of the participation problem stem from: (1) unexplored tensions within the Gothenburg consensus paper and other formative documents in the development of HIA; (2) inherent tensions arising from the dual origins of HIA, specifically Environmental Impact Assessment (EIA) and Healthy Public Policy (HPP); and (3) a lack of rigour and clarity relating to the terminology of community participation where community participation is used as a ‘catch all’ phrase for every situation without critical examination. In order to move debate forward, the authors advance a model, the Typology of Public Involvement in HIA, for guiding discussion of community participation. This model comprises a set of context-specific HIA approaches with varying degrees of public involvement. The model also presents a suite of defined terms for understanding and discussing participation.
Article
Within environmental sociology realist critiques of the use of social constructionist approaches abound. This paper challenges features of the realist critique and emphasises the appeal and utility of social constructionist approaches for the study of environmental issues. We start by outlining the criticisms levelled at social constructionism, particularly the claim that the approach amounts to a denial of the existence of environmental problems and provides no contribution to managing them. We argue that this characterisation of `extreme' constructionism is problematic in two senses. First, in that it bears little resemblance to the mild approach actually used in the majority of empirical studies and, secondly, that it is a misleading characterisation of a more radical constructionism. We conclude that the utility of constructionism can be formulated in terms of two distinct approaches. One refrains from making overt moral and political claims, and treats such claims as topics for analysis; such an approach can, however, provide resources for social criticism. Another adopts an overtly political or environmentally motivated stance towards the issues investigated. Underlying these suggestions is our conviction that a particular model of engagement is implicit in many realist critiques and that others are possible, and perhaps, preferable.
Article
Health Impact Assessment (HIA) is a relatively new, but increasingly important, contributor to both local and national decision-making processes. Adopting a multi-method approach, it incorporates qualitative and quantitative analyses to determine the various health impacts of policies and projects. HIA thus reflects recent developments in sociological theory, which have promoted qualitative techniques and challenged the dominance of quantitative methods. HIA embodies a particular renegotiation of the qualitative/quantitative opposition; each individual HIA represents an empirical instance of this renegotiation. As such, HIA can be conceptualized as a kind of ‘political space’, in which the opposition in question is structured by various social forces and plays out in concrete ways. Moreover, and notwithstanding the supposed methodological rapprochement, an analysis of a number of HIAs claims to expose a continuing, but perhaps unsurprising, privilege in favour of quantitative methods. In the first place, the paper contends that closer examination reveals this privileging to be unjustified, both empirically and theoretically, and alternative methodological and epistemological configurations are suggested accordingly. Specific gestures are made in this respect toward the work of Martin Heidegger and Jacques Derrida. In particular, the paper argues for a broad hermeneutic approach that both encompasses and situates the methodological tensions HIA stages. Second, attention is drawn to the fact that various and particular sociopolitical conditions maintain the characteristic architecture of the opposition. The political importance of HIA across a series of key issues is underscored in support of a more radical interpretation. For once situated within its wider cultural context, HIA ceases to resemble some straightforwardly neutral technology for health protection and delivery. If, instead, one reads it as an indicative micropolitical phenomenon, then one can begin to interrogate this simple policy tool in more complex ways. HIA both reveals, and is implicated in, a more fundamental and diffuse process that is presently resisting, undermining and regenerating traditional power distributions within the administration of health and beyond. The paper implicitly argues that HIA can only be properly understood within this context and, equally, allows one a certain analytical access to this context.
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"This new edition of Social Determinants of Health takes account of the most recent research in the field, and includes additional chapters on ethnicity and health, sexual behaviours, the elderly, housing, and neighbourhoods. It is written by acknowledged experts in each field, using non-technical language to make the book accessible to students and those with no previous expertise in epidemiology. This volume provides the evidence behind the WHO initiatives on the social determinants of health, known as The Solid Facts handbook.". "Social Determinants of Health is the most comprehensive, ground-breaking, and authoritative survey of research findings in this field, and is a must for everyone interested in the wellbeing of modern societies. Public health professionals, health promotion specialists, and anyone working in the many fields of public policy will engage with the issues raised in this book."--BOOK JACKET.
Article
An idea whose time has come The Health of the Nation, England's strategy for a healthy population, acknowledges explicitly that many government policies have an impact on health and that their consequences for health need to be assessed and, when appropriate, taken into account.1 England is not alone: the idea of health impact assessment is almost universally popular, though its implementation is patchy. In the developing world, where the importance of healthy public policy is well understood, the prospective assessment of the health impact of resource allocation policies or of development projects is nothing new.2 3 In the developed world, however, acknowledgement of the need for health impact assessment is still in its early stages, and its meaning, methods, and application remain to be established. Only now is the scientific community coming to realise the crucial role of public and private policies and projects in influencing the public's health. The Commission of the European Union has recently stated that article 129 of the European Union Treaty “requires the Commission to check that proposals for policies, and implementing measures and instruments, do not have an adverse impact on health, or create conditions which undermine the promotion of health.”4 Such an acknowledgement is well overdue, given the European Union's current policies of funding the promotion of whole fat dairy produce and tobacco production.5 In the United Kingdom the need for health impact assessment as an integral feature of policy development and evaluation is no less pressing. There are many examples of adverse effects on health that a prospective assessment of the health impact of public policy could help avoid. These include the increased incidence of myocardial infarction that results from work environments which place high psychological demands on workers but allow them little scope for decision making and control of those demands6; the motor vehicle accidents associated with transport policies that put freedom of traffic flow above the safety needs of communities7; and the increased poverty and exposure to cold caused by the imposition of value added tax on fuel.8 In this context the recent publication of a British government booklet on policy appraisal and health9 is welcome—as is its distribution to local authorities as well as to the health sector in England. But its exclusive focus on economic appraisal methods of health impact assessment puts at risk its otherwise laudable objectives. Impact assessment for outcomes other than health has become established in the developed world in recent decades, most notably as a result of the United States' National Environmental Policy Act of 1969. This act was rapidly followed by the development and implementation of methods for environmental (and later for social) impact assessment,10 focusing chiefly on the identification, assessment, and management of risk.11 Methods for assessing the impact of policy (as distinct from policy evaluation, which examines the extent to which a policy meets its stated objectives) are still in the formative stages.12 13 14 15 Emerging methods for health impact assessment are likely to draw heavily on the experience of practitioners in these closely related fields. The methods all emphasise the importance of focusing on equitable outcomes; explicitly targeting disadvantaged groups; enabling the full participation of those likely to be affected by the policy or project; and using qualitative as well as quantitative methods of inquiry. The economic contribution is but one important element within a multidisciplinary framework broad enough to encompass the wide range of impacts on health. The need for a broad framework, and not simply one that concentrates on economic methods and outcomes, was confirmed in the United Kingdom's sole example of a completed prospective health impact assessment, which assessed the potential health impact of an additional runway at Manchester Airport (K Ardern, personal communication). While the government's initiative represents a welcome foot in this particular door, much still remains to be done before evidence based policy making can become a reality.16 References1.↵Secretary of State for Health.The health of the nation.A strategy for health in England. London: HMSO,1992.2.↵Dahlgren G.Strategies for health financing in Kenya—the difficult birth of a new policy.Scand J Soc Med 1990;46(suppl):67–81.3.↵Birley MH.The health impact assessment of development projects. London: HMSO,1995.4.↵Commission of the European Communities.Report from the commission to the council, the European parliament and the economic and social committee on the integration of health protection in community policies. Brussels: CEC,1995. (COM (95)196 final of 29 May 1995.)5.↵Rayner M.European Union policy and health.BMJ 1995;311: 1180–1.OpenUrlFREE Full Text6.↵Karasek R, Theorell T.Healthy work. New York: Basic Books,1990.7.↵Beattie A, Gott M, Jones L, Sidell MHillman M.Social goals for transport policy. In:Beattie A, Gott M, Jones L, Sidell M, eds.Health and wellbeing: a reader. Basingstoke: Macmillan,1993: 237–47.8.↵Watt GCM.Health implications of putting value added tax on fuel.BMJ 1994;309: 1030–1.OpenUrlFREE Full Text9.↵Department of Health.Policy appraisal and health. London: Department of Health,1995. (EL(95)129/CI(95)47.)10.↵Vanclay F, Bronstein DA, eds.Environmental and social impact assessment. Chichester: Wiley,1995.11.↵Ewan C, Young A, Bryant E, Calvert D.National framework for environmental and health impact assessment.National Health and Medical Research Council. Canberra: Australian Government Publishing Service,1994.12.↵Milio N.Promoting health through public policy. Philadelphia: FA Davis,1981.13.↵Robson B, Bradford M, Deas I, Hall E, Harrison E, Parkinson M.et al.Assessing the impact of urban policy. London: HMSO,1994.14.↵Vanclay F, Bronstein DABoothroyd P.Policy assessment. In:Vanclay F, Bronstein DA, eds.Environmental and social impact assessment. Chichester: Wiley,1995: 83–126.15.↵Costongs C, Springett J.A conceptual evaluation framework for health-related policies in the urban context. Liverpool: Institute for Health, Liverpool John Moores University,1995.16.↵Ham C, Hunter DJ, Robinson R.Evidence based policy making.BMJ 1995;310: 71–2.OpenUrlFREE Full Text
Article
The effect of the translation and deployment of science by development proponents in the impact assessment process is examined. Basslink, the 300 km power cable to transport electricity across Bass Strait, is the case study. Drawing on the sociology of science, this paper analyses one critic's contestation of the Basslink proponent's science. It highlights the extent to which impact assessment statements fortify proponents' knowledge-claims, obscuring from view the conditionality of science, and making these claims resistant to independent critique, analysis and verification. These circumstances have the potential to undermine the effectiveness, equity and transparency of regulatory instruments and enforcement mechanisms that derive from the impact assessment process as well as the regime's legitimacy.
Article
Using the synergies between strategic environmental evaluation and HIA to advance the integration of environmental and health issues in public decision-making processes The Geneva rule was the first one in Switzerland to introduce the concept of Strategic Environmental Assessment (SEA). This assessment constitutes a decision making aid which describes the process set up to allow evaluation of potential environmental impact and comparison of possible variants, recommends the choice for the best option and suggests the precautions to take. It presents much resemblances to HIA. In this case therefore the application of SEA in the urban planning project MICA has been presented. It is in this framework that a first experience of integration HIA to the SEA process was realized. In an additional way to SEA, HIA is focused on the following fields of potential impact: transport and movements, housing, public facilities, water management.
Article
Internationally the inclusion of health within environmental impact assessment (EIA) has been shown to be limited. While Australian EIA documentation has not been studied empirically to date, deficiencies in practice have been documented. This research developed an audit tool to undertake a qualitative descriptive analysis of 22 Major Project EAs in New South Wales, Australia. Results showed that health and wellbeing impacts were not considered explicitly. They were, however, included indirectly in the identification of traditional public health exposures associated with the physical environment and to a lesser extent the inclusion of social and economic impacts. However, no health data was used to inform any of the assessments, there was no reference to causal pathways between exposures or determinants and physical or mental health effects, and there was no inclusion of the differential distribution of exposures or health impacts on different populations. The results add conceptually and practically to the long standing integration debate, showing that health is in a position to add value to the EIA process as an explicit part of standard environmental, social and economic considerations. However, to overcome the consistently documented barriers to integrating health in EIA, capacity must be developed amongst EIA professionals, led by the health sector, to progress health related knowledge and tools.
Article
Reducing health inequities and improving the health of communities require an informed public that is aware of the social determinants of health and how policies and programs have an impact on the health of their communities. People Assessing Their Health (PATH) is a process that uses community-driven health impact assessment to build the capacity of people to become active participants in the decisions that affect the well-being of their community. The PATH process is both a health promotion and a community development approach that builds people's ability to bring critical analysis to a situation and to engage in effective social action to bring about desired change. Because it increases analytical skills and provides communities with their own unique tool to assess the potential impact of projects, programs or policies on the health and well-being of their community it is an empowering process. PATH was originally used in three communities in northeastern Nova Scotia, Canada in 1996 when the Canadian health care system was being restructured to a more decentralized system. Since then it has been used in other communities in Nova Scotia and India.This paper will describe the PATH process and the use of the community health impact assessment as well as the methodology used in the PATH process. The lessons learned from PATH's experiences of building capacity among the community in Canada and India will be presented.
Article
The object of the health impact assessment (HIA) was to inform economic development of a neighbourhood in Sheffield (England) and to use HIA as a tool to increase the participation of local communities in strategic development decisions. Community profiling and literature review was followed by analysis and prioritisation of policy and health impacts, and recommendations for policy change. A series of Standing Conferences were used to bring community, statutory and private sector perspectives together for debate. The paper reflects upon the extent to which the economic, environmental, and social HIA recommendations have been implemented, 2 years on. It concludes that most progress has been made where lobbying and action by local groups has been able to bring about change. Unsurprisingly regional and national policy making has proved harder to influence. Involvement of two community partnership groups was important in building community involvement. The learning is summarised in a 10 point list of factors which enable HIA to make a difference. It is concluded that participatory HIA can not only assist in identifying the integrated solutions which sustainable development requires, but also helps form the partnerships and alliances required to realise such solutions.
Article
This book covers the lifelong importance to health of determinants such as poverty, drugs, working conditions, unemployment, social support, good food and transport policy. It provides a discussion of the social gradient in health, and an explanation of how psychological and social influences affect physical health and longevity. The focus is on the role that public policy can play in shaping the social environment and on structural issues such as unemployment, poverty and the experience of work. Each of the chapters contains a brief summary of what has been established by research, followed by some implications for public policy. [Country: Europe]
Article
To explore some of the strengths and weaknesses of purely quantitative approaches used in health impact assessment (HIA) and the implication of this for policy making. The studies presented generally used a variety of quantitative risk assessment (QRA) methodologies. For each population, concentration-response (CR) or exposure-response (ER) functions, typically expressed as percentage change in health effect per unit change in concentration or exposure, were applied to estimates of population exposure and background rates of morbidity and mortality in order to calculate the attributable health impact or burden. In some cases, this burden was then costed according to standard economic models. In most of the studies discussed, where a reliable CR or ER relationship was available, it was possible to quantify the impact(s) of the relevant environmental stressors on health, and to estimate the associated uncertainties. QRA has an important role in producing estimates for the health impacts of those risk factors where there is a sufficient base of research to quantify relationships between population exposure and health, and to predict the effects of policies on population exposure. However, quantified HIA is not an infallible process and can give an illusion of certainty that belies the complexity of the interactions involved, particularly where multiple determinants of health are likely to be affected. It is important that any uncertainties associated with that which has been quantified, as well as the likely impacts of that which cannot be quantified, are assessed and represented comprehensively. A simplistic application of QRA estimates is an inadequate HIA, as it may encourage policy makers and others to attach more importance to those impacts that are easier to quantify but which do not necessarily have the greatest associated burden.