• Many of the early gains in public health were linked to improving the environmental factors that cause disease• The environmental determinants of health• You’ll learn more about these during the course
Much of this disease still has environmental causes Many of the new causes of disease seemed to be different in nature to traditional environmental health concernsUnder-considered factors that powerfully influence healthand health related behaviours
NSW Health (2006) Report of the NSW Chief Health Office, NSW Health: Sydney.http://www.health.nsw.gov.au/public-health/chorep/dia/dia_typehos.htm
Schroder S. (2007) We Can Do Better: Improving the health of the American people. NewEngland Journal of Medicine, 357, 1221-1228.
What determines health? (A fuzzy pie chart) Genetics Opportunities/ 10-25% Socioeconomic Status 20-30%Risk Factors 20-40% Health Environment Services & Place 15-30% 5-15%
Dahlgren G, Whitehead M. (1991) Policies and Strategies to Promote Social Equity in Health.Stockholm: Institute of Futures Studies.
The Social Determinants of Health• Stress• Early life• Social exclusion• Work• Unemployment• Social support• Addiction• Food• Transport• The social gradient in health
Health Statistics NSWhealthstats.nsw.gov.au/Indicator/ses_lomidhiavodth
Murphy M et al. (2006) TheWidening Gap in Mortality byEducational Level in theRussian Federation, 1980-2001. American Journal ofPublic Health, 96:1293–99.cited inMarmot M. (2007) AchievingHealth Equity: From rootcauses to fair outcomes.Lancet, 370:1153-1163.
A combination of procedures, methods and tools by which a policy, program or project may be assessed for its potential and often unanticipated effects on the health of the population and the distribution of these impacts within the population. Gothenburg Consensus PaperEuropean Centre for Health Policy (1999) Gothenburg Consensus Paper on Health ImpactAssessment: main concepts and suggested approach, WHO Europe: Brussels (adapted byMahoney & Morgan).
HIA is a developing approach that can help to identify and consider the potential - or actual - health impacts of a proposal on a population. Its primary output is a set of evidence-based recommendations geared to informing the decision making process. Taylor & QuigleyTaylor L, Quigley R. (2002) Health Impact Assessment: A review of reviews. London: NationalHealth Service, Health Development Agency.
Key Aspects of HIA• A prospective activity• Uses a combination of methods• Looks at intended and unintended impacts• Looks at the distribution of impacts• Results in evidence- informed recommendations
Explicit Focus on the Distribution of Impacts1. Age2.Gender3.Socioeconomic status4.Location5.Ethnicity and culture6.Existing levels of health anddisability
Thinking about the distribution of impacts: Avoidability and fairness Lead exercise
Determinant of Health Difference Avoidable? Fair?1. Natural biological variationChildren absorb lead more quickly than adults2. Health damaging behaviour if freelychosenExposure to lead through lead lighting as ahobby3. Transient health advantageThe lead in the land around the houses in anaffected area is being removed. Some peoplewill have their houses done before others.4. Health-damaging behaviour where choiceof lifestyle is restricted by socioeconomicfactorsIf a low income family rents close to a leadsmelter because of cost despite knowing itmay be damaging the health of their children
Determinant of Health Difference Avoidable? Fair?5. Exposure to excessive health hazards inthe physical and social environmentPeople in mining communities chose to workin the mine despite knowing of the harm totheir health6. Restricted access to essential healthrelated careChildren whose development has beenaffected by exposure to lead have limitedaccess to special education classes7. Health -related social mobilityWorkers who have been exposed to lead overmany years, often prior to understanding ofthe risks, may be forced to retire early
The Steps of HIA• Screening• Scoping• Identification• Assessment• Decision-making and recommendations• Evaluation and follow-up
Assessment Recommendations If you These will be If you make These will beimplement the the impacts these changes the gains proposal
Where does health risk assessment (HRA) fit in?
HRA is a structured framework for assessing risks associated with environmental hazards (prospectively and retrospectively)
“The process of estimating the potentialimpact of a chemical, biological, physical orsocial agent on a specified human populationunder a specific set of conditions and for acertain time frame’ enHealth HRA Guidelines
Scoping ActivityMaster Plan for Cheonggyecheon, Seoul
• Proponent receptive to HIA, but must be completed in 5 months (mustn’t hold up construction!)• Proponent is Seoul City Government, who are reasonably convinced the proposal is a good idea• Proponent has asked that the HIA’s focus should be on improving proposal and tweaking, not suggesting new major initiatives or “vetoing” the initiative
Group work – scoping exercise1. What impacts should be considered in the HIA?2. How should the HIA be conducted? Whatmethods could you use to collect information aboutpotential impacts?3. What resources would be required to undertakethe HIA? (Money, skills, etc)
Environmental health Social view of health EquityEach bring with them their own disciplinary beliefs, values, support base and baggage
HIA Health Equity Social View of Health Environmental Health Regulatory Environmental Impact Assessment Environmental Disasters1950s 1960s 1970s 1980s 1990s 2000s1956 Clean Air Act (UK) 1962 Silent Spring 1972 Lake Pedder Dam 1980 The Black Report 1990 Concepts & 2004 Equity Focused HIA controversy (UK) Principles of Equity Framework (Australia) in Health (Australia)1959 Minamata Bay 1969 Santa Barbara 1980 International (Japan) Channel (USA) 1990 Environmental 1972 The Indian Wildlife Association for 2005 Health included in Protection Act (UK) (Protection) Act Impact Assessment IFC Performance 1969 US National formed Standards Environmental 1992 Asian Development Policy Act (USA) 1974 Lalonde Report Bank HIA (Canada) 1984 Bhopal (India) 2005 Guide to HIA in the Guidelines Oil and Gas Sector 1969 Cuyahoga River 1974 Environmental 1986 Ottawa Charter Fire (USA) 1994 Framework for Protection (Impact 2007 1st Asia-Pacific HIA Environmental and of Proposals) Act Conference 1986 Chernobyl Health IA (Australia) (Australia) (Ukraine) (Australia) 1978 Seveso (Italy) 2007 HIA’s use included 1989 Exxon Valdez Oil 1997 Jakarta Declaration in Thailand’s Spill (USA) Constitution 1978 Love Canal (USA) 1998 Independent 1978 WHO Seminar on 2008 WHO Commission Inquiry into Environmental on the Social Inequalities in Health Impact Determinants of Health (UK) Assessment Health: Closing the (Greece) Gap in a 1998 Merseyside Generation Guidelines for HIA 1978 Declaration of 2009 Montara West Alma Ata 1998 The Solid Facts Atlas Oil Spill (Australia) 1979 Three Mile Island (USA) 1999 Gothenburg 2010Marmot Review Consensus Paper on HIA
This diversity is widespread and the challenges efforts to make HIA embedded in the policy development and decision making processExample: Lack of consensus about HIA from the National Public Health Partnership But also enables responsiveness to emerging issues
Section 7What type of things are HIAs done on?
Source: Harris E, Baum F, Harris-Roxas B, Kemp L, Spickett J, Keleher H, HarrisM, Morgan R, DannenbergA, Sukkumnoed D, Wendel A. The effectiveness of health impact assessments conducted in Australia andNew Zealand; Australian Research Council Discovery Project Grants; 2010-2011. [DP1096211]
Source: Winkler M etal. (2013) Untappedpotential of healthimpact assessment,Bull World HealthOrgan 2013;91:298–305.doi:10.2471/BLT.12.112318
Types of Health ImpactsSource: Harris-Roxas B, Harris P. Learning by Doing: The value of case studies of health impact assessment. NSW Public Health Bulletin,2007:161-163.
Source: The Rise of HIAs in the United Stateshttp://www.pewhealth.org/reports-analysis/data-visualizations/the-rise-of-hias-in-the-united-states-85899464695
Increasingly also on:• Climate change (adaptation)• Transition-to-town issues (food miles, sustainability, etc)• Energy• Social programs and education
Section 8How does HIA fit in with environmental health?
Environmental health issues are considered in every HIA, such as:1. Vector-related diseases2. Respiratory and housing issues3. Veterinary medicine/zoonotic issues4. Sexually transmitted infections5. Soil- and water-borne diseases6. Food- and nutrition-related issue7. Accidents/injuries8. Exposure to potentially hazardous materials9. Psychosocial10. Cultural health practices11. Health services infrastructure and capacity12.Noncommunicable Diseases (NCDs)
HIA moves beyond describing the effects of the environment on health to doing something about it HIA brings together population health activity -health protection (environmental health) and health improvement It’s a practical tool to improve the consideration of health and environmental health in planning and decision-making