The view that health ismerely the absence of illness and disease
controlling theenvironmental causes of disease =dealing with most public health concerns or does it?
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
sanitationvoted the most important medicaladvance since 1840.
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• .
Barton H, Grant M. (2006) A Health Map for the Local Human Habitat. Journal of the RoyalSociety for the Promotion of Health, 126, 252-253.
NSW Health (2006) Report of the NSW Chief Health Office, NSW Health: Sydney.http://www.health.nsw.gov.au/public-health/chorep/ses/ses_lomidhilex.htm
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
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
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) 1 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) 1 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 Health IA (Australia) (Australia) (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
Mandated Decision Support• If HIA is mandated the • If decision support forms process will have to be are pursued the process is more prescribed, more chaotic• standards of practice will (more of a process than a need to be described, methodology)• tighter definitions of • Less clarity about who will evidence that can be do it and where it might sit challenged in court will need within organisations to be determined,• accreditation of practitioners• Triggers will need to be clear• Clarification of the roles & responsibilities of proponents of government policy
Advocacy Community Empowerment• Seeks to reframe or • Difficulty: no control over challenge issue/proposal process or decisions• Requires a close link to • Community unlikely to be evidence to be credible bound by disciplinary• Hard to involve proponents traditions/evidence and decision-makers • Often linked to social• Who would do it routinely learning, i.e. changing is unclear understandings, enabling• Often seeks to bring in dialogue other evidence/only • Is a democratic and political selective evidence process, rather than a• May have an agenda – technocratic or rational need to be explicit about process this • May look quite different to other HIAs
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 8What type of things are HIAs done on?
Types of Health ImpactsHarris-Roxas B, Harris P. Learning by Doing: The value of case studies of healthimpact assessment. NSW Public Health Bulletin, 2007:161-163.
Increasingly also on:• Climate change (adaptation)• Transition-to-town issues (food miles, sustainability, etc)• Energy• Social programs and education•.