Health Impact Assessment

1
Health Impact Assessment

• Gabriel Gulis, PhD
• University of Southern Denmark
• Institute of Public Health
• Unit of Health Promotion Research
• Niels Bohrvej 9-10
• 6700 Esbjerg
• Denmark
• Telephone [phone]
• Telefax 45 65504283
• E-mail ggulis_at_health.sdu.dk

2
Learning objectives

• To get familiar with the health impact assessment
• To understand the objectives of health impact
  assessment
• To understand basic methodological steps of
  health impact assessment

3
Performance objectives

• To be able to recognize a need for health impact
  assessment
• To be able to outline a health impact assessment
  for the selected case
• To be able to establish a team for conduct of
  health impact assessment

4
Why do I like health impact assessment ?

• I was used to work in hygiene service in Slovak
  Republic and it had been required by law since
  1966 that each decision should be approved by
  district hygienist, it means some kind of health
  impact assessment had been expected.
  Unfortunately, the practice was not always so.
  Working as director of the National Health
  Promotion Center, I realized that health impact
  assessment is much more then a step within
  licensing procedure and I started to do research
  in this field. The broad field which must be
  covered and the variety of inter-relations
  explored by a truly health impact assessment is
  an amazing field of public health with no respect
  to national or local level or selected topic to
  assess.

5
Health impact assessment (HIA)

• Environmental, social, economic, etc. impact
  assessments
• Assessment evaluation
• Health impact assessment - any combination of
  procedures or methods by which a proposed policy
  or program may be judged as to the effects it may
  have on the health of a population3

6
Health impact assessment

• Health impact assessment - a methodology which
  enables the identification, prediction and
  evaluation of the likely changes in health risk,
  both positive and negative, single or collective,
  of a policy programme, plan or development action
  on a defined population. These changes may be
  direct and immediate or indirect and delayed

7
HIA development

• EIA legislation 1969
• 1991 and later in 90s more and more countries
  includes HIA into expertise's, New Zealand,
  Australia, British Columbia in Canada, etc.
• In Europe Germany and the Netherlands mostly
  environmental health issues, Finland, Sweden
  other general policy or specific policy issues in
  90s
• 1998 strong movement in United Kingdom, major
  documents came out
• Epidemiology, environmental health, risk
  assessment, sociology, politology, communication,
  etc.

8
Amsterdam treaty of ECarticle 152

• a high level of human health protection shall be
  ensured in the definition and implementation of
  all Community policies and activities
• http//ue.eu.int/Amsterdam/en/traiteco/en1.htm
• TITLE XIII Article 152
• European council resolution of June 1999 calls
  for establishment of procedures to monitor the
  impact of Community policies and activities on
  public health and health care

9
Gothenburg consensus paper

• Values governing HIA
• Democracy
• Equity
• Sustainable development
• Ethical use of evidence
• Elements of HIA
• Evidence
• Opinions
• Informed understanding
• Adjustment/options

10
HIA of the EU Common Agriculture Policy

• Dahlgren, Nordgren, Whitehead, National Institute
  of Public Health, Sweden, 199621
• Health impacts of
• CAP of fruit and vegetable
• CAP of diary products
• CAP of tobacco regime
• CAP of alcohol regime

11
Merseyside steering group

• Community safety projects5
• International astronomy and space exploration
  centre14
• Integrated transport strategy5
• Drug prevention initiative5
• King George V playing fields project5
• And many others5

12
Edinburgh

• City of Edinburgh Councils Urban Transport
  strategy5
• North Edinburgh area renewal housing strategy5

13
London

• Greater London Authoritys Biodiversity Strategy5
• Greater London Authority Economic Development
  Strategy5

14
Impact of US embargo on health in Cuba

• Combine effects of a severe economic decline
  since 1989 and a tightening of the US embargo in
  1992 on health and health care in Cuba16

15
Waste management and airports

• Health impact of Nant-y-Gwyddon landfill site5
• Solid waste facilities in Canada5
• Third runway at Sydneys Kingsford-Smith Airport5
• Manchester airport5
• Schiphol airport Amsterdam5

16
HIA methodologies

• 16 different models or guidance's recognized in
  literature!
• The Merseyside guidelines1
• A 10 step risk assessment model of the University
  of Bielefeld20
• General model20

17
The Merseyside guidelines

• Apply screening criteria to select project or
  policy
• Establish steering group
• Agree terms of reference for assessment
• Select assessor
• Conduct assessment
• Appraise the assessment
• Negotiate favored options
• Implement and monitor
• Evaluate and document

18
The Merseyside guidelines assessment step

• Conduct assessment
• Policy analysis
• Profiling of communities
• Interview stakeholders and key informants
• Identify health determinants affected, collect
  evidence from previous reports
• Assess evidence
• Establish priority impacts
• Recommend and justify options for action

19
A 10 step risk assessment model (Bielefeld model)

• Project analysis
• Regional analysis
• Population analysis
• Background analysis
• Prognosis of additional pollution
• Prognosis of health impact
• Summarizing assessment of impacts
• Recommendations
• Communication
• Evaluation

20
General model

• Screening
• Scoping
• Risk assessment
• Decision making
• Implementation and monitoring

21
Screening

• Preliminary assessment to see if the project or
  policy is likely to pose any significant health
  questions and is therefore worth to subjecting to
  health impact assessment
• Positive or negative expectations?

22
Scoping

• Outlining the possible hazards and benefits and
  identifying the questions that must be asked in
  the assessment process
• Frequently referred to as setting of terms of
  reference
• Baseline level?
• What would happen if the funds needed to
  implement the assessed project or policy will be
  devoted to other project or policy?

23
Risk assessment

• Characterization of nature and magnitude of
  harmful and beneficial factors
• How many and which people will be affected by
  them
• How they will be affected
• Negative factors mitigation
• Positive factors - maximalization

24
Decision making

• Choice of options, including no action option
• Final recommendation including mitigation or
  maximalization strategies

25
Implementation and monitoring

• Recommendation of actions to implement decision
  and to observe the consequences
• Monitoring and communication
• Evaluation and communication

26
Key problems

• Levels individual, social group, community,
  region, country, international
• Measures what kind of measures on which step
• Stakeholders health professionals, other
  professionals, community, public, etc.
• QA/QC
• Political acceptance (community) why some
  politicians ask for HIA and others do not
• Prospective versus retrospective

27
Literature and information sources

• www.ihia.org.uk
• http//www.msoc-mrc.gla.ac.uk/Reports/PDFs/Occasio
  nal-Papers/OP-002.pdf
• http//www.who.dk/eprise/main/WHO/Progs/HPA/Health
  Impact/20020319_1
• http//www.hc-sc.gc.ca/hppb/healthpromotiondevelop
  ment/pube/impact/impact.htm
• http//www.publichealth.bham.ac.uk/hiaru/
• http//www.euro.who.int/eprise/main/WHO/Progs/HMS/
  Home
• Lerer LB Health impact assessment, Health Policy
  and Planning, 14(2), 198-203
• Kemm J. Health impact assessment a tool for
  Healthy Public Policy, Health Promotion
  International, Vol 16, No.1, 79-85
• Beecham L All policies should be assessed for
  effect on health, BMJ, 1998 316 1558
• Parry J., Stevens A Prospective health impact
  assessment pitfalls, problems, and possible ways
  forward, BMJ, 2001 323 1177-82
• Mittelmark MB Promoting social responsibility
  for health health impact assessment and healthy
  public policy at the community level, Health
  Promotion International, Vol. 16, No. 3, 269-274
• Mooy JM, Gunning-Schepers LJ Computer-assisted
  health impact assessment for intersectoral health
  policy, Health Policy 57 (2001), 169-177
• Mindell J, Hansell A., Morrison D., Douglas M,
  Joffe M What do we need for robust, quantitative
  health impact assessment, Journalm of Public
  Health Medicine, Vol. 23, No. 3, p. 173-178
• Winters LY A prospective health impact
  assessment of the international astronomy and
  space exploration centre, J. Epidemiol Community
  Health, 2001 55 433-441
• Douglas MJ, Conway L, Gorman D, Gavin S, Hanlon
  P Developing principles for health impact
  assessment, Journal of Public Healt medicine,
  Vol. 23, No. 2, p. 148-154
• Garfield R, Santana S The impact of the economic
  crisis and the US embargo on health in Cuba,
  American Journal of Public Health, Vol. 87, No.
  1, p. 15-20
• Mahoney M, Morgan RK Health impact assessment in
  Australia and New Zealand an exploration of
  methodological concerns, Promot. Educ. 2001,
  8(1), 8-11
• Scott-Samuel A Health impact assessment-theory
  into practice, J. Epidemiol Community Health,
  1998 52704-705
• Scott-Samuel A Health impact assessment, BMJ
  1996 313 183-184