22 April 2015

Community environmental health risk indicator for outdoor pollutants and health determinants

Array of problems and opportunities but limited funds.

Air pollution is the important environmental factor.

CHERIO looks at time lost each year due to ill health, disability and early death due to environmental exposure.

Cumulative health impact ie % total disease burden. Range of different levels across The Netherlands.

Scenario of a cut in traffic generates increases and decreases i.e. a shift in disease burden which if not spatially analysed shows no change in disease burden.

Can analyse by socio-economic or other characteristics.

Can help prioritisation, comparison of alternatives, monitoring/benchmarking.

Environmental Act

Data availability at a local scale

Use this as part of assessment.

21 April 2015

Capturing vulnerability using open data and GIS

Women's health and extractive industries in Northern British Columbia.

Violence against women is a big issue.

Gold mine near Fort St James in northern part of BC.

EIA seen as a regulatory hurdle and does not look at health issues in detail.

Currently data sharing agreement reached and community research advisory board set up

Communit health baseline has been developed.

Commercial sex became. a big issue that included these women being murdered.

Communities have universities to do research and impact assessment work on the impact of mining on these communities.

Increased vulnerability of women and youth?
Increased crime
Increased pressure on health care services

Four indicators being used
General health status
Endemic violence
Substance misuse
Women's vulnerability

Hoping to develop a social vulnerability index to focus mitigation and monitoring.

A gap in knowledge and practice
not significant 

Use this information to understand context and assess risks.

Procedural effectiveness of the new EHIA, Thailand

EIA legislation timeline in Thailand.

1970s and 80s EIA legislation developed.
2000s health came on the agenda.

What is procedural effectiveness?
Effectiveness is made up of procedural, substantive, transcribe and normative.

18 EHIA reports of which 3 are for power plants.

Seven criteria:
Policy and procedures
Institutional practice 
EHIA integration in planning
FInancial funds
Stakeholder involvement
Clarity of EHIA as evidence in decision making

Some projects start construction before approval of EHIA has been given.

Based on this work An eighth criteria should be added in relation to timing enforcement.

Effective regulatory effectiveness is key.

Impact grid for health assessment of hydroelectric

EIA they do not include health impact acts derived from environmental impacts.

Build and analyse the network of health impacts due to environmental aspects regarding hydroelectric construction.

Case study of Rondônia

A suggestive approach of the health impacts concerning a national hydroelectric on most common impacts related to environmental factors.

Positive impacts
Creation of permanent jobs 
Increase of income
Urban development 

Negative impacts
air pollution
sexually transmitted disease 

Impact Network example
Worker camp changed land use leading to loss of flora be fauna and mercury contamination from existing industrial and artisanal and forest burning and deforestation leading to loss of lora and fauna which in turn lead to changes in infectious parasitic diseases and contribution to climate change.

Also leading to other chronic diseases and increase in accidents caused by local workers being able to buy motorbikes and cars.

Increase in calorie sense foods.

Lack of quantitative data

Published studies on dams

Health costs and impacts neglected by developers/proponents.

IAIA15: HIAs in the transport sector

Connections with EIA and SEAN in Styria, Austria.

Majority of disease burden caused by transport
Health has to be viewed as cross-departmental
EIA mandatory 1994
HIA not mandatory

Identify opportunities for cooperation of health in EIA.

Key conclusions
Variety of facilitating and inhibiting factors.
SEAs has the potential to integrate HIAs
Integration of HIA and EIA recommended
Integration of HIAs in EIA in transport sector.
Integration of HIAs in SEAs
Disinclination to accept new instruments 
Big interest in transport sector but topics with conflict

Inter sectoral cooperation is a barrier
Political support a facilitator

fIrst piece of work on HIA and transport in Austria.

First pilot HIA has been carried out.

Health considerations within EIA in Kenya?

Research undertaken on EIA/SEA framework and how health operationalised in Kenya in EA practice.

EA frameworks include health but not broad enough and may dilute environmental impacts.

In Kenya 2.5 million people have been pushed into poverty because of policy implemented on paying for health care service use.

50 respondents (consultants, researchers, some others).

Majority agreed that health is not only about absence of disease.

But said yes it is about biophysical factors affecting health.

While there was disagreement about considering social determinants.

Wanted more guidance material specific to Kenya.

Felt health can only be cover health superficially.

Recommendations made by respondents
  • Want health objectives
  • Want obligatory requirements
  • Need health to be integrated in EA and economic development 
  • Need enforcement
  • Need training for EA experts
  • Need community empowerment

Evolving Practices of HIA: Qou Vadis

May own experience on how HIA has changed.

Pre-2009: 77% HIA done after ESIA, 50% retrospective 

After 2009: 33% HIAs done after ESIA

Integration in management plans

No HIA performed because of legal framework before or after 2009.

Public domain reports 0% to 8% (4).

Stakeholder engagement 

Mainly mining projects in Sub-Saharan Africa.

Barriers and opportunities 
No frameworks in high and low income countries for mining, health and EA. So variation in company standards and no one to hold to account.

Significant health costs particularly TB and chronic lung disease. HIV also a big issue.

Too narrow a definition of health in guidelines.

Interaction health authorities locally is challenging.

Strong occupational health regulation none for community health.

Health in EA is an untapped potential to improve public health locally.

Weak monitoring and evaluation of health findings.

What is the gap between the projects that don't consider health at all?

Need for better health regulations.

Intersectional collaboration.

Documents public and community aware and can read/understand findings.

Host governments leading not just lending institutions and companies.

Health in EA: Cross-institution approaches to integrated assessment

This is about The Lothian Region in Scotland.

Not so much about EA and health more Health in Environmental and Equalities Impact Assessment 

Equalities Impact is about considering key groups interns of potential for discrimination.

A range of assessments are undertaken and it makes sense to integrate.

Each Local government has its own unique approach often.

Have been trying for a while to develop a shared approach it has not succeeded because different departments doing each IA, the lead person leaves, etc...

When Integrated Health and Social Care Boards came in a window of opportunity appeared to develop an integrated approach.

Differing perspectives and tensions about evidence, stakeholder involvement and council priorities.

Developed an evidence checklist and a structured discussion group using a checklist to prompt discussion on impacts.

The process of the IIA is as shown above. There are branches out to SEA or other assessments.

The group meeting involves:
"Structured brainstorm"
meeting to agree and share responsibility for findings and recommendations.
Shared learning

Example of IIA of a Staff Travel Plan:
Helped identify a broader range of impacts and issues than each individual assessment.

Barriers: attitudes
Facilitator: seeing it in practice
Recommendations: understand other people's must dos

Health In EIA: Institutional approaches

What can we do to make health assessment better in EIA?

What institutional barriers, facilitators and recommendations can be made?

Health considerations within EIA in Kenya?

Research undertaken on EIA/SEA framework and how health operationalised in Kenya in EA practice.

EA frameworks include health but not broad enough and may dilute environmental impacts.

In Kenya 2.5 million people have been pushed into poverty because of policy implemented on paying for health care service use.

50 respondents (consultants, researchers, some others)

Majority agreed that health is not only about absence of disease.

But said yes it is about biophysical factors affecting health.

While there was disagreement about considering social determinants.

Wanted more guidance material specific to Kenya.

Felt health can only be

Recommendations made by respondents
Want health objectives
Want obligatory requirements
Need health to be integrated in EA and economic development 
Need enforcement
Need training for EA experts
Need community empowerment

20 April 2015

IAIA15: EU Impact Assessment Systems: to which extent a global model

EU Impact Assessment process has developed over the last decade and 80% of impact assessmenst are sent back for further improvement when first submitted.

No explicit health dimension in regulatory and policy level impact assessment.

SEA Directive: strengths, weakneses and applicability beyond EU
SEA Directive is a framework not a blueprint i.e. minimal standards, non-procedural, national transposition with additional requirements.

Impact-centred SEA approach - not so much applicable to policies.

10,000 SEAs undertaken to date!

Plans and programs at national, regional, local and transboundary levels and their amendments.

Sets framework for carrying out EIA.

Undertaken before plan or programmes adopted - becoming ex ante.

Tiering provisions avoiding duplications in assessments is increaisngly being used.

Scoping consultations and nevironmental and health authorities - arrangements and quality vastly differs.

Anlysis requires:
Dynamic baeline
Relevant environmental problem
Relationship with environmental policy objectives
More and more assessment of health and consideration fo transboundary impacts alongside transboundary impacts (alongside environmental impacts).

Environmental and increasingly health authorities.

Decision making and follow up:
Outcomes of consultations and SEA report are taken into account.
Adopted PP
How were SEA outcomes considered.

SEA increasingly looked at during funding applications for major projects. Ex ante conditionality of capacitybuilding for EIA and SEA in countries where projects are situated.

Example of an SEA in Turkey.

IAIA15 HIA Connectors: yesterday, evening out before conference start

Today is the formal start of the International Association for Impact Assessment's Annual Conference in Florence, Italy. But yesterdy and even more important informal event. The first get together of the IAIA15 HIA Connectors.

We had a great turn out at the get together on yesterday evening. I was a bit shocked at how many managed to meet up. There was fourteen of us (not counting a little someone who had early tears observer status)!

A chance for people new to the IAIA conference to meet up with HIA/public health colleagues from  around the world.

16 April 2015

Research Associate post in Transport and Health at University College London

Applicants are invited for a Research Associate position in an exciting cross-faculty research project: Street mobility and accessibility: developing tools for overcoming older people’s barriers to walking to develop tools to measure and model community severance. The main responsibility will be to analyse questionnaire data from the case studies, and assist with project management.
Community severance (CS) arises when transport infrastructure or the speed or volume of traffic prevent people from accessing goods, services or people. Effects include reduction in social networks and psychological barriers to use of streets for walking or social spaces. Health effects are assumed but have not been studied. More information about the project can be found at www.ucl.ac.uk/street-mobility
This is a full-time post however we will consider applicants who wish to work less than full time.
The post is funded until 31st December 2016 and is available from 1st July 2015 (or by negotiation) in the first instance.
Key Requirements
Applicants must have a PhD in a relevant area or equivalent research experience, experience in working in surveys and/or analysing survey data (including larger data sets), and an understanding of the process of carrying out academic research and surveys. Proven ability and commitment to carry out and complete high quality original research and publication of original research papers in peer reviewed journals are essential, as are excellent interpersonal, oral and communication skills.  Project management experience is desirable.
The closing date is 28th April 2015; interviews will probably be first week of May.

For more information: click here ( Reference 1458689)

1 April 2015

Opportunity: Recruitment for Health Impact Assessment Consultant

Go to ADB site by clicking here.

If you have any questions, Dr Susann Roth is the contact (sroth@adb.org)

Scope of Work
The consultant will have three main tasks: 
1. Strengthen ADB’s HIA tools, applications, and project screening, 
2. Strengthen and support the policy dialogue on HIA in the Greater Mekong Sub-region (GMS), 
3. Work with infrastructure projects (ADB and private sector) to develop 
in collaboration with Civil Society Organizations (CSOs) malaria screening and treatment activities linked to workers and communities 
involved in infrastructure projects.

Detailed Tasks and/or Expected Output
The consultant will develop and implement an HIA tool for ADB’s infrastructure projects and for developing member countries to apply for non-ADB-financed infrastructure projects. The consultant’s tasks will include the following:
• Finalizing ADB working paper on HIA and developing HIA assessment tools for ADB;
• Working closely with Operational Departments specifically in the transport and energy sector groups.
• Developing screening method for projects which need HIA and developing database for ADB projects;
• Developing training material for ADB staff on HIA;
• Discussing possible projects which benefit from HIA with ADB team leaders and propose actions;
• Conducting desk review and stakeholder consultations, including with private sector, on existing HIA tools in GMS countries;
• Conducting in-country consultation workshops with stakeholders on HIA policies and implementations and need to strengthen those;
• Identifying collaboration partners in each country;
• Determining feasibility and develop an HIA tool for use by local governments and private companies to reduce transmission risks for 
communicable diseases;
• Working with local governments to apply the HIA tool in at least four ADB/and or private sector infrastructure projects in areas with 
high risks of malaria; 
• Sharing lessons from implementing the HIA tool with stakeholders;
• Collaborating closely with national malaria programs and Mahidol Oxford Research Unit on identifying geographic malaria hot spots;
• Collaborating with various regional stakeholders such as PSI, WHO, Myanmar Business Coalition on Aid; and
• Leading the preparation and conduct of GMS regional workshop on HIA with government, development partners and private sector.

• A finalized working paper on HIA at ADB
• Finalized guidelines for HIA for ADB projects
• Regular discussions with team leaders including commenting on ADB projects which need HIA
• Conduct of regional workshop on HIA with government, development partners, private sector (material, agenda etc.)
• Presentation material on HIA
• HIA assessment of 4 ADB projects
• Action Plan on HIA recommendation for 4 projects
• Identification of suitable CSOs to implement action plan (related to malaria prevention and treatment of workers)

Minimum Qualification Requirements
Educational Background
Degree in public health, medical science, medicine, occupational health or related fields. Additional training in health impact assessment is a must.

Professional Background
10 years of experience in public health and health impact assessment. Experience working in Southeast Asia (Cambodia, Lao PDR, Myanmar, Viet Nam, Thailand). Experience working with private sector on hIA of infrastructure projects. Experience in policy dialogue with  Governments on HIA.

Minimum General Experience 15 Years
Minimum Specific Experience  (relevant to assignment) 10 Years
Regional/Country Experience Desired

31 March 2015

Mercury puts Arctic kids at risk

There is a long standing debate about the benefits of eating fish particularly for pregnant women and unborn children because of high levels of mercury in fish.
A recently published study shows how high intake of mercury is damaging brain development in Inuit children in the Arctic Quebec, Canada. Children’s IQ level was found to be linked to the intake of  marine animals with high mercury levels e.g. beluga whale, seal, walrus as well as fish.
Pregnant women in the Arctic have been urged to eat more Arctic Char as it is currently considered to be less contaminated.
The high exposure of mercury not only affects children’s IQ it can also effect attention, motor skills, heart rate and lead to respiratory problem and ear infections.

Jacobson JL, Muckle G, Ayotte P, Dewailly É, Jacobson SW. Relation of Prenatal Methylmercury Exposure from Environmental Sources to Childhood IQ. Environ Health Perspect; http://dx.doi.org/10.1289/ehp.1408554. Advance Publication: 10 March 2015
Although prenatal methylmercury exposure has been linked to poorer intellectual function in several studies, data from two major prospective, longitudinal studies yielded contradictory results. Associations with cognitive deficits were reported in a Faroe Islands cohort, but few were found in a study in the Seychelles Islands. It has been suggested that co-exposure to another contaminant, polychlorinated biphenyls (PCBs), may be responsible for the positive findings in the former study and that co-exposure to nutrients in methylmercury-contaminated fish may have obscured and/or protected against adverse effects in the latter.
To determine the degree to which co-exposure to PCBs may account for the adverse effects of methylmercury and the degree to which co-exposure to docosahexaenoic acid (DHA) may obscure these effects in a sample of Inuit children in Arctic Québec.
IQ was estimated in 282 school-age children from whom umbilical cord blood samples had been obtained and analyzed for mercury and other environmental exposures.
Prenatal mercury was related to poorer estimated IQ after adjustment for potential confounding variables. The entry of DHA into the model significantly strengthened the association with mercury, supporting the hypothesis that beneficial effects from DHA intake can obscure adverse effects of mercury exposure. Children with cord mercury ≥ 7.5 μg/L were four times as likely to have an IQ score below 80, the clinical cut-off for borderline intellectual disability. Co-exposure to PCBs did not alter the association of mercury with IQ.
To our knowledge, this is the first study to document an association of prenatal mercury exposure with poorer performance on a school-age assessment of IQ, a measure whose relevance for occupational success in adulthood is well established. This association was seen at levels in the range within which many U.S. children of Asian American background are exposed.

Full Article:  click here

5 March 2015

Trading away Health: Reflections on an HIA of a trade agreement”

Guest post by Fiona Haigh:
The HIA team at CHETRE has been working with a group of Australian academics and non-government organisations to carry out a health impact assessment (HIA) on the Trans Pacific Partnership Agreement (TPP) negotiations. The report has attracted a lot of attention and in general has been a different experience from the typical HIAs that we are involved in. We thought it would be interesting to share with the HIA community a few reflections on our experience.
We weren’t commissioned to do this HIA- a small group of us thought it would be a good and interesting thing to do and we somehow managed with some support from CHETRE and the Public Health Association of Australia keep it going. The support from CHETRE enabled us to bring in Katie Hirono to do a lot of the work on it and we were supported by a group of experts and advocacy groups who contributed their expertise and advice. There were some technical challenges to do with trying to do an HIA on something that is being kept secret. We had to base our assessment on leaked documents on wikileaks and advice from academics working in the area and policy experts. We also faced the challenge of trying to predict likely future public health policies that could be impacted on by the trade agreement (since it won’t affect current policies). We approached this by working with policy experts to identify likely future public health policies in our scoped areas of focus that would be impacted on by the TPP.
We also walked the talk of taking a participatory approach, which meant sharing power with the technical advisory group and the advocacy groups that we worked with throughout the process. We feel that this has worked really well- it meant that we focused on issues they identified as important and we have produced a report that they have been able to immediately use for their advocacy. Without them I’m pretty sure this report would not be having the impact it has had so far. The report is being talked about on the front pages of major newspapers, there have been multiple radio interviews, a social media campaign led by CHOICE (the main consumer advocacy group in Australia), lots of tweets and perhaps most satisfying of all we’ve been labeled scaremongers in a press release from the minister for trade and investment - we must be doing something right!

3 March 2015

Health Impact Assessment of the Proposed Trans-Pacific Partnership Agreement

An HIA of the Trans-Pacific Partnership Agreement (TPP) has just been released, authored by Katie Hirono, Fiona Haigh, Deborah Gleeson, Patrick Harris and Anne Marie Thow.

From the media release:

Report finds medicine affordability, public health policies at risk in Trans Pacific Partnership
A report released today by a large team of academics and non-government health organisations reveals that the Trans-Pacific Partnership Agreement (TPP) poses risks to the health of Australians in areas such as provision of affordable medicines, tobacco and alcohol policies and nutrition labelling. Many public health organisations have been tracking the progress of the TPP negotiations over the past several years and have expressed concerns about the potential impacts and lack of transparency. 
“The TPP includes provisions that don’t just affect trade. They affect the way the Government regulates public health,” said Michael Moore, Chief Executive Officer (CEO) of the Public Health Association of Australia (PHAA). “In many areas – such as nutrition labelling - it’s already a struggle to implement effective policies that promote health. If certain provisions are adopted in the TPP, this will be another hurdle for organisations seeking positive public health outcomes.”
The report also argues that: “The TPP risks increasing the cost of the Pharmaceutical Benefits Scheme (PBS), which is likely to flow on to the Australian public in terms of increased co-payments (out-of-pocket expenses) for medicines”. An increase in co-payments risks declining public health and increasing hospitalisations, particularly for people who are already disadvantaged.
A team of researchers from UNSW Australia, Sydney University and La Trobe University conducted the health impact assessment based on leaked documents from the trade negotiations.
“In the absence of publicly available current drafts of the trade agreement, it is difficult to predict what the impacts of the TPP will be,” said Dr Deborah Gleeson, one of the report’s authors. “In the study, we traced the potential impacts based on proposals that have been - or are being - discussed in the negotiations. But the only way to properly assess the risks is to allow a comprehensive health impact assessment to be conducted on the final agreement before it gets signed by Cabinet.”
The report offers a set of recommendations to the Department of Foreign Affairs and Trade to reduce the likelihood that the TPP will negatively impact health in Australia. Such recommendations include excluding an investor-state dispute settlement (ISDS) mechanism, and including strong wording to ensure that public health takes priority where there is a conflict with trade concerns. The report also recommends that Government change its approach to conducting trade agreements, for example by publishing draft texts and negotiating positions on issues of public interest.
Trade negotiators are meeting next week in Hawaii. The Minister for Trade and Investment, Andrew Robb, has said he anticipates the negotiations will wrap up within the next few months.
“It’s vitally important that health is given high priority in the final stages of the negotiations,” said Lynn Kemp, Director, Centre for Health Equity Training, Research and Evaluation. “We urge the Australian Government to consider these issues seriously.”
The HIA report can be accessed here.