Health impact assessment - University of Pittsburgh

Health impact assessment - University of Pittsburgh

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: +45 65504212 Telefax: +45 65504283 E-mail: [email protected] Numbers in superscripts refer to refer ences on last slide 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 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

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. 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 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 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. Amsterdam treaty of EC article 152 a high level of human health protection shall be ensured in the definition and implementation of all Community policies and activities 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 Gothenburg consensus paper Values governing HIA:

Democracy Equity Sustainable development Ethical use of evidence Elements of HIA Evidence Opinions

Informed understanding Adjustment/options HIA of the EU Common Agriculture Policy Dahlgren, Nordgren, Whitehead, National Institute of Public Health, Sweden, 1996 21 Health impacts of

CAP of fruit and vegetable CAP of diary products CAP of tobacco regime CAP of alcohol regime Merseyside steering group Community safety projects5 International astronomy and space exploration centre14 Integrated transport strategy 5 Drug prevention initiative5 King George V playing fields project 5 And many others5

The cases listed on the following f ive slides refer to different topics HIA has been completed Edinburgh City of Edinburgh Councils Urban Transport strategy5 North Edinburgh area renewal housing strategy5 London Greater London Authoritys Biodiversity Strategy5 Greater London Authority Economic

Development Strategy5 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 Waste management and airports Health impact of Nant-y-Gwyddon landfill site5

Solid waste facilities in Canada 5 Third runway at Sydneys Kingsford-Smith Airport5 Manchester airport5 Schiphol airport Amsterdam 5 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

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 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 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 General model Screening Scoping Risk assessment Decision making Implementation and monitoring 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? 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? 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

Decision making Choice of options, including no action option Final recommendation including mitigation or maximalization strategies Implementation and monitoring Recommendation of actions to implement decision and to observe the consequences Monitoring and communication Evaluation and communication 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 Literature and information sources 1. 2. 3. 4. 5. 6. 7. 8. 9.

10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 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), 811 Scott-Samuel A: Health impact assessment-theory into practice, J. Epidemiol Community Health, 1998; 52:704-705 Scott-Samuel A: Health impact assessment, BMJ 1996; 313: 183-184 Developing health impact assessment in Wales, Better Health Better Wales, National Assembly of Wales, Health Promotion Division, ISBN 0 7504 2374 9 Dahlgren G, Nordgren P, Whitehead M: Health impact assessment of the EU Common Agricultural Policy, National Institute of Public Health, 1997:36, Stockholm, Sweden Banken R: Strategies for institutionalizing HIA, ECHP Health Impact Assessment Discussion papers, Number 1, September 2001

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