A prospective health impact assessment of the Merseyside Integrated Transport Strategy (MerITS)

BACKGROUND: Prospective health impact assessment is a new approach to predicting potential health impacts of policies, programmes or projects. It has been widely recognized that public policies have important impacts on health. In 1997, the Liverpool Public Health Observatory was commissioned to carry out a health impact assessment of the Merseyside Integrated Transport Strategy (MerITS). A secondary aim was to pilot a method for health impact assessment at the strategic level. METHODS: The methods used drew on previous health impact assessments of projects, on strategic environmental assessment, and on policy research. They included policy analysis, semi-structured interviews with key informants and literature searches. RESULTS: Four priority impact areas of MerITS were identified: establishing road hierarchies, economic viability, air quality, and public transport. Potential health impacts in each of these areas were estimated, and recommendations were made to minimize the effects of negative impacts and to enhance positive ones. CONCLUSION: This health impact assessment prospectively identified the key health impacts of a strategy on a defined population and made recommendations to maximize potential positive and minimize potential negative health impacts. The methods employed are generally applicable to prospective health impact assessments of public policies and strategies.     

Health impact assessment.

There is growing concern about the environmental, social and health consequences of development projects. Environmental impact assessment (EIA), which aims to address this concern, is often conducted with little input from the health sector. Quantifying the health benefits and risks of a project or policy requires an innovative synthesis of socio-demographic, environmental health, epidemiological and health systems data. This article provides a simple framework for health impact assessment (HIA), a method for describing and measuring the impact of a project or policy on health and wellbeing, and designing appropriate interventions. The key components of HIA are: review of available data; research and identification of priority health issues through the use of rapid assessment methods; design of a health action plan with stakeholder consultation; implementation of interventions and the monitoring of long-term health impacts. HIA can assist in ensuring that development and policies are 'health promoting' and that the health sector plays a meaningful role in EIA.     

A health impact assessment model for environmental changes attributable to development projects

STUDY OBJECTIVE: European Union legislation requires large industrial and civil development projects to undergo environmental impact assessment. The study objective was to identify environmental health risk estimates for these developments from the epidemiological literature and to develop, and apply these within, a mathematical health impact assessment model. Design and results: In the UK, good practice guidelines have set out environmental issues to be considered in development projects, but little attention is given to direct health effects. Broad quantifiable risks were identified for four-air, chemicals, noise, and road traffic-of 14 standard environmental effects. A mathematical model was constructed that is based on people moving between different health states over their lifetime. Age related hazard functions are applied to cause specific measures of mortality and morbidity. A hypothetical example for a development creating air and chemical pollutants is given. CONCLUSIONS: A mathematical model applying epidemiological risks to an exposed population can provide quantification of environmental health effects. The approach may in future find application during project development, and by public health regulatory authorities for environmental health impact assessment.     

Growing the field of health impact assessment in the United States: an agenda for research and practice

Health impact assessment (HIA) methods are used to evaluate the impact on health of policies and projects in community design, transportation planning, and other areas outside traditional public health concerns. At an October 2004 workshop, domestic and international experts explored issues associated with advancing the use of HIA methods by local health departments, planning commissions, and other decisionmakers in the United States.Workshop participants recommended conducting pilot tests of existing HIA tools, developing a database of health impacts of common projects and policies, developing resources for HIA use, building workforce capacity to conduct HIAs, and evaluating HIAs. HIA methods can influence decisionmakers to adjust policies and projects to maximize benefits and minimize harm to the public's health.     

Health impact assessment of building and investment projects

For regional planning and approval procedures for building projects of a certain order of magnitude and power rating according to the German Federal Act on the Prevention of Emissions with Integrated Environmental Impact Assessment (EIA), the German public health departments, acting as public authorities, increasingly perform health impact assessments (HIA). The amended Act on Environmental Impact Assessment, the Decree on industrial plants which require approval (4th Federal Decree on Emission Prevention) and the Health Service Acts of the Federal States of Germany form the legal basis for the assessment of health issues with regard to approval procedures for building and investment projects. In the framework of the "Action Programme for the Environment and Health", the present article aims at making this process binding and to ensure responsibility and general involvement of the Public Health departments in all German Federal States. Future criteria, basic principles and procedures for single-case testing as well as assessment standards should meet these requirements. The Federal Ministry for the Environment and the Federal Ministry for Health should agree on Health Impact Assessment (HIA ) as well as on the relaxant stipulations in their procedures and general administrative regulations for implementing the Environmental Impact Assessment Act (EIA). Current EIA procedures focus on urban development and road construction, industrial investment projects, intensive animal husbandry plants, waste incineration plants, and wind energy farms. This paper illustrates examples meeting with varying degrees of public acceptance. However, being involved in the regional planning procedure for the project "Extension of the federal motorway A 14 from Magdeburg to Schwerin", the Public Health Service also shares global responsibility for health and climate protection. Demands for shortest routing conflict with objectives of environmental protection which should be given long-term consideration. Assessing the direct impact of projects on human beings should be rank first in the list of priorities. The Hygiene Institute supports the efforts of the Public Health departments by providing professional consultant services to ensure consistency in the application of procedures.     

Health impact assessment: an introduction to the what,why and how

It is now widely recognised that policies, programs and projects within the health and other public and private sectors can have significant and often unintended negative impacts on health and well‐being . Health Impact Assessment (HIA) is one way of assessing and addressing these impacts prior to implementation. In many countries, including Australia, HIA has traditionally been undertaken as part of environmental impact assessment and translating the HIA process to this broader focus has raised some important issues, particularly whether the ‘value add’ of HIA outweighs the time and resources required. This paper aims to provide an introduction to HIA, a rationale of why you might use HIA in the project, program or policy development cycle, the steps that are generally followed in undertaking a HIA, and identification of some useful websites. We would encourage you to contribute to the knowledge in this field by ‘learning by doing’.     

Supporting health impact assessment in practice

Health impact assessment (HIA) is a process that aims to predict potential positive and negative effects of project, programme or policy proposals on health and health inequalities. It is recommended by national government and internationally. Supporting health impact assessment is one of the roles of English Public Health Observatories. The few centres in England with accredited health impact training centres have inadequate resources to meet demand. Currently, the London Health Observatory is providing the bulk of the training nationally. Some Public Health Observatories are currently investigating the preferences for support of those commissioning or conducting health impact assessment within their regions. The availability of published guidance on how to conduct health impact assessments has increased substantially over the past few years. The Department of Health has funded a research project led by the London Health Observatory to develop advice for reviewing evidence for use in health impact assessment. Completed health impact assessments can be useful resources. Evaluation of the process and impact of health impact assessment is important in order to demonstrate its usefulness and to learn lessons for the future. The focus for Public Health Observatories is to train and support others to conduct health impact assessment according to good practice, rather than undertaking health impact assessments themselves. The aim is to create sufficient skilled capacity around the country to undertake health impact assessments. The London Health Observatory plans to share its support models and to roll out a train the trainer programme nationally to enable effective local delivery of their national health impact assessment programme.     

Evaluating health impact assessment

Health impact assessment (HIA) is a developing approach that assesses the health impacts of a proposal on a population, and produces a practical set of recommendations to inform the decision-making process of the proposal. The purpose is to influence decision makers to increase positive health impacts of a proposal and decrease negative impacts. Most work within the HIA field to date has focused on methodological development and actually carrying out HIAs. Little attention has been paid to the formal evaluation of the HIA approach and whether or not HIA works (if and how the HIA approach informs the decision-making process and, in particular, if it contributes to improving health and reducing inequalities). With the drive towards evidence-informed policy, HIA also needs to show whether it adds value to the decision-making process, given the significant resources often involved in carrying out an HIA. A suggested approach to evaluating HIAs is presented, as well as its relationship with monitoring, drawing on the significant public health evaluation literature that already exists. Methodologies appropriate for use, and examples of indicators suitable for HIA evaluation, are provided. We suggest that typical HIA evaluations should focus on the process of the HIA and the impact that it has on the decision-making process, rather than attempting to evaluate long-term health outcomes or whether predicted impacts actually occurred.     

An equity-focussed social impact assessment of the Lower Hunter Regional Strategy

The Lower Hunter Regional Strategy prepared by the Hunter Department of Planning identifies how development in the region will be managed on a sustainable basis over the next 25 years. In order to inform decision-makers about the potential social and health impacts arising from the proposed population increase, the Hunter Regional Coordination Management Group, in collaboration with the NSW Premier's Department and Hunter New England Health, completed an equity-focussed social impact assessment of the strategy. The assessment illustrates how equity can be systematically addressed within an impact assessment process and provides insight into the mechanisms which led to equity considerations influencing the policy and planning agenda.     

Methodologies for realizing the potential of health impact assessment

Health impact assessment (HIA), a systematic assessment of potential health impacts of proposed public polices, programs, and projects, offers a means to advance population health by bringing public health research to bear on questions of public policy. The United States has been slow to adopt HIA, but considerable strides have been made in many other countries, and under the auspices of the World Health Organization and World Bank. Varied applications in these diverse milieu have given rise to diverse approaches to HIA-quantitative/analytic, participatory, and procedural-each with distinct disciplinary foundations, goals, and methodologies. Suitability of these approaches for different applications and their challenges are highlighted, along with areas in which methodologic work is most needed and most likely to advance the field from theory and infrequent application to more routine practice in the United States.     

Bungendore health impact assessment: urban development in a rural setting

As the majority of the determinants of health are controlled outside the health system, the challenge for promoting health is to find a way of influencing these determinants. Health impact assessment was used in Bungendore, NSW, in an attempt to influence decisions relating to scenarios for urban development. Twelve months after the project was completed, interim evaluation has revealed evidence that the health impact assessment has had a positive effect on preliminary land-use planning work.     

国际健康影响评价的制度建设：从政策到法律

健康影响评价来源于环境影响评价，“健康的公共政策”运动促进其进一步发展。世界各国的健康影响评价工作主要由公共卫生部门、非政府组织或者国际组织主导，应用于政策、规划和项目三个层面，以系统地评价其带来的潜在健康风险。健康影响评价广泛涉及环境、产业、社会以及城市化等多种领域，是一种多学科、跨部门的影响评价工具。健康影响评价按时间顺序分为前瞻性健康影响评价、回顾性健康影响评价和和即时性健康影响评价。从国际经验来看，健康影响评价立法大致分为三类：一是国家宪法先行，如泰国。二是地方立法先行，如加拿大和澳大利亚。三是环境影响评价立法中包含健康影响评价的条款，这是美国等世界大部分国家通行的一种健康影响评价立法方式。建议我国健康影响评价立法，可以针对国家可持续发展议程创新示范区、高风险行业如火电等行业、重大影响的项目、规划或者政策开展。     

A prospective health impact assessment of the international astronomy and space exploration centre

STUDY OBJECTIVES: Assess the potential health impacts of the proposed International Astronomy and Space Exploration Centre on the population of New Wallasey. Contribute to the piloting of health impact assessment methods. DESIGN: Prospective health impact assessment involving brainstorming sessions and individual interviews with key informants and a literature review. SETTING: New Wallasey Single Regeneration Budget 4 area. PARTICIPANTS: Key stakeholders including local residents' groups selected through purposeful snowball sampling. MAIN RESULTS: Recommendations are made that cover issues around: transport and traffic; civic design; security; public safety, employment and training. CONCLUSIONS: Health impact assessment is a useful pragmatic tool for facilitating wide consultation. In particular engaging the local population in the early planning stages of a proposed development, and assisting in highlighting changes to maximise the positive health influences on affected communities.     

Moving forward in health impact assessment: analysis of the non-health public policies of the Basque Government (Spain) as step prior to systematic screening

Health not only depends on biologic or lifestyle factors but also on other economic, social, political, and environmental factors that shape the way people live and become ill. Thus, health policies are not the only policies affecting health, and consequently governments are increasingly interested in identifying the effect of other non-health policies on health. Health impact assessment is a prospective methodology that aims to predict the health impacts of policies before their implementation so that modifications can be suggested to maximize positive effects and avoid unexpected negative repercussions on health. The first stage in this process is screening, which can be used to select the interventions that could benefit from complete health impact assessment. Since resources are limited and not all government interventions can be assessed, tools that allow prioritization are essential. As a first stage in the validation of a systematic screening tool for health impact assessment in Spain, this article presents the process of compiling and classifying the non-health public policies of the eighth term of office of the Basque Government. Of the 97 policies analyzed, 76% were related to structural determinants of health inequalities, 79% were tactical or operational, 67% were aimed at specific population groups, and 66% were already implemented. The technical staff of other participating departments perceived the entire process of this initiative and its rationale positively. This initial experience allowed the planning of non-health policies in the Basque Country to be determined in detail as a means to move forward in incorporating impact on health in all policies.     

Comparative assessment of transport risks--how it can contribute to health impact assessment of transport policies

Health impact assessment (HIA) and comparative risk assessment (CRA) are important tools with which governments and communities can compare and integrate different sources of information about various health impacts into a single framework for policy-makers and planners. Both tools have strengths that may be combined usefully when conducting comprehensive assessments of decisions that affect complex health issues, such as the health risks and impacts of transport policy and planning activities. As yet, however, HIA and CRA have not been applied widely to the area of transport. We draw on the limited experience of the application of these tools in the context of road transport to explore how comparative assessment of transport risks can contribute to HIA of transport policies.     

Institucionalización de la evaluación del impacto en la salud en Andalucía

Health impact assessment (HIA) aims to incorporate people's health and wellbeing as a key feature in policy-making. Many authors believe that HIA might be systematically integrated into all decision-making processes as a way to achieve that goal. To that end, there is need to overcome a number of challenges, including the fact that Andalusia (Spain) has made HIA compulsory by law, the need for awareness of all public sectors whose decisions might have substantial impacts on health and for a methodology that would enable a comprehensive approach to health determinants and inequalities, and the training of both the public health staff and professional sectors responsible for its application. In Andalusia, a law provides mandatory and binding health impact reports for most authorisation procedures in different areas: from sectoral plans to urban planning schemes, and especially projects subject to environmental assessment. Implementation of this law has required its integration into authorisation procedures, the training of interdisciplinary working groups in public health, the preparation of technical guidelines, and the organisation of dissemination and training seminars for developers.     

Mini-symposium — Public Health Observatories: Supporting health impact assessment in practice

Health impact assessment (HIA) is a process that aims to predict potential positive and negative effects of project, programme or policy proposals on health and health inequalities. It is recommended by national government and internationally. Supporting health impact assessment is one of the roles of English Public Health Observatories. The few centres in England with accredited health impact training centres have inadequate resources to meet demand. Currently, the London Health Observatory is providing the bulk of the training nationally. Some Public Health Observatories are currently investigating the preferences for support of those commissioning or conducting health impact assessment within their regions. The availability of published guidance on how to conduct health impact assessments has increased substantially over the past few years. The Department of Health has funded a research project led by the London Health Observatory to develop advice for reviewing evidence for use in health impact assessment. Completed health impact assessments can be useful resources. Evaluation of the process and impact of health impact assessment is important in order to demonstrate its usefulness and to learn lessons for the future. The focus for Public Health Observatories is to train and support others to conduct health impact assessment according to good practice, rather than undertaking health impact assessments themselves. The aim is to create sufficient skilled capacity around the country to undertake health impact assessments. The London Health Observatory plans to share its support models and to roll out a train the trainer programme nationally to enable effective local delivery of their national health impact assessment programme.     

Environmental health impact assessment: evaluation of a ten-step model.

"Environmental impact assessment" denotes the attempt to predict and assess the impact of development projects on the environment. A component dealing specifically with human health is often called an "environmental health impact assessment." It is widely held that such impact assessment offers unique opportunities for the protection and promotion of human health. The following components were identified as key elements of an integrated environmental health impact assessment model: project analysis, analysis of status quo (including regional analysis, population analysis, and background situation), prediction of impact (including prognosis of future pollution and prognosis of health impact), assessment of impact, recommendations, communication of results, and evaluation of the overall procedure. The concept was applied to a project of extending a waste disposal facility and to a city bypass highway project. Currently, the coverage of human health aspects in environmental impact assessment still tends to be incomplete, and public health departments often do not participate. Environmental health impact assessment as a tool for health protection and promotion is underutilized. It would be useful to achieve consensus on a comprehensive generic concept. An international initiative to improve the situation seems worth some consideration.     

Health and environmental impact assessment in Canada

Potential health effects of proposed development activities are an important component of environmental impact assessment (EIA). I report results of a survey to determine the nature and extent of health impact assessments in EIA in Canada. Most proponents conduct health impact assessments when there is an identified health concern. However, few Canadian jurisdictions require health impact assessments in their EIA legislation. The extent to which health is considered depends on several factors and concerns can be addressed at several different stages of the EIA process. Health impact assessments have dealt with a wide range of concerns, although the specific health issues addressed depend on the nature of the project. Several procedures and methods have been used by proponents and government reviewers. Often health impact assessments are qualitative or rely on relevant standards or guidelines. Occasionally, quantitative risk assessments are conducted. Survey respondents identified several problems which hinder health impact assessments including a shortage of suitably trained and experienced health professionals, inadequate communications between government agencies and insufficient or conflicting scientific data to allow accurate prediction of any health effects.     

Integrated environmental impact assessment: a Canadian example

The Canadian federal process for environmental impact assessment (EIA) integrates health, social, and environmental aspects into either a screening, comprehensive study, or a review by a public panel, depending on the expected severity of potential adverse environmental effects. In this example, a Public Review Panel considered a proposed diamond mining project in Canada's northern territories, where 50% of the population are Aboriginals. The Panel specifically instructed the project proposer to determine how to incorporate traditional knowledge into the gathering of baseline information, preparing impact prediction, and planning mitigation and monitoring. Traditional knowledge is defined as the knowledge, innovations and practices of indigenous and/or local communities developed from experience gained over the centuries and adapted to local culture and environment. The mining company was asked to consider in its EIA: health, demographics, social and cultural patterns; services and infrastructure; local, regional and territorial economy; land and resource use; employment, education and training; government; and other matters. Cooperative efforts between government, industry and the community led to a project that coordinated the concerns of all interested stakeholders and the needs of present and future generations, thereby meeting the goals of sustainable development. The mitigation measures that were implemented take into account: income and social status, social support networks, education, employment and working conditions, physical environments, personal health practices and coping skills, and health services.