Health 2020 - new World Health Organization Europe Initiative

International experts in public health met on 14 October 2010 to map out the broad goals and targets of the new European health policy, HEALTH2020, at a meeting in Copenhagen, Denmark.

Discussion focused on four key questions.

• What is today’s context for health policy in a fast-changing Europe?
• What is the scope of the policy, including its target audiences and main products?
• What values, guiding principles and evidence base should support HEALTH2020?
• What process should be used to develop the policy, which includes involving partners and identifying key milestones?

The policy is being developed to accelerate progress towards achieving the European Region’s health potential by 2020 by addressing key public health and health policy challenges. WHO/Europe seeks to engage and consult with a diverse range of stakeholders to ensure that a spectrum of views informs the development of the policy and can sustain it in the longer term.

A draft policy framework is expected to be presented at the next meeting of the WHO Regional Committee for Europe in 2011, and finalized in 2012.

Health 2020 aims to confirm the underlying values and principles, and provide for an integrated and consistent framework to address the recent challenges to health and health equity in Europe.

A new study on health inequalities in Europe will provide a basis for this health policy. This study will analyze the social determinants of health, in particular as they affect the health divide in Europe, as well as the social gradient in societies, vulnerable population groups, gender and the impact of all these aspects on health policies and actions by governments. It will also address all the other determinants of health, such as lifestyles, the environment and climate change, and food safety.

see WHO Europe news item

see Zsuzsanna Jakab, WHO Regional Director for Europe's speech and presentation on Health 2020 at the World Health Summit

Courtesy of the European Public Health Alliance

Research Priorities for Assessing Health Effects from the Gulf of Mexico Oil Spill: A Letter Report

The US National Academy of Sciences has just reported back on what they consider are the key research priorities and issues that need to be taken forward in relation to oil spills and human health.

Click here to go to the page and download a free pdf of the report (after registering).

The 5 research priorities they identified are:

Research priority 1
Evidence about the psychological and behavioral effects of the Gulf of  Mexico oil spill. Policymakers and health officials can use such evidence to guide efforts to improve the health status of individuals affected by the Gulf of Mexico oil spill, as well as contribute to the prevention and treatment of similar health outcomes in future disasters. The research should identify factors associated with either vulnerability or resilience to situations such as oil spills and other disasters.

Research priority 2
Obtaining information that is as comprehensive as possible about exposure to the oil, dispersants, and by-products of the controlled burns.

Research priority 3
Assessing seafood safety in both the near term and long term and clearly communicating results to the affected communities.

Research priority 4
Research to evaluate and compare communication and engagement methods to determine which are the most effective for disaster and disaster-preparedness research.

Research priority 5
Research on the framework needed to deploy a rapid research response for future oil spills and other potential disasters.

Image courtesy of Wikipedia from an original NASA photo. Click here to go to the Wikipedia page.

Converting streets into running tracks: 'Ready Steady Go'

'Ready. steady. go!', is an installation by austrian architects Sandra Janser and Elisabeth Koller which is meant to provide a visual frame within the Jakomini district of Graz, Austria.

The intention of the project is to define the streets of jakoministraße and klosterwiesgasse, by marking them as a significant design area within the city.

Check out more photos and details at Designboom by clicking here.

Real world reviews: a beginner’s guide to undertaking systematic reviews of public health policy interventions

Very interesting article  in the Journal of Epidemiology and Community Health on undertaking useful systematic reviews when time and resources are limited.

Click here to go the JECH webpage and download the whole Editor's Choice article for free.

My Favourite Quotes:

Systematic reviews are interested in locating and synthesising the ‘best available evidence’(not all available evidence); this means that the hierarchy of

evidence does need to be applied albeit in a pragmatic way. 

‘Pragmatist’ systematic reviews therefore focus on a handful of ‘first-line’ health and social science databases, or supplement this with the use of a subject specialist one, while ‘purist’ systematic reviews have tended to search every available and potentially relevant electronic database.

ARTICLE ABSTRACT

Background

The systematic review is becoming an increasingly popular and established research method in public health. Obtaining systematic review skills are therefore becoming a common requirement for most public health researchers and practitioners. However, most researchers still remain apprehensive about conducting their first systematic review. This is often because an ‘ideal’ type of systematic review is promoted in the methods literature.

Methods

This brief guide is intended to help dispel these concerns by providing an accessible overview of a ‘real’ approach to conducting systematic reviews. The guide draws upon an extensive practical experience of conducting various types of systematic reviews of complex social interventions.

Results

The paper discusses what a systematic review is and how definitions vary. It describes the stages of a review in simple terms. It then draws on case study reviews to reflect on five key practical aspects of the conduct of the method, outlining debates and potential ways to make the method shorter and smarterdenhancing the speed of production of systematic reviews and reducing labour intensity while still maintaining high methodological standards.

Conclusion

There are clear advantages in conducting the high quality pragmatic reviews that this guide has described: (1) time and labour resources are saved; (2) it enables reviewers to inform or respond to developments in policy and practice in a timelier manner; and (3) it encourages researchers to conduct systematic reviews before embarking on primary research. Well-conducted systematic reviews remain a valuable part of the public health methodological tool box. 

More scepticism about the value of HIA

"In the absence of more information and public policy debate, it is difficult to image how the HIA process can add any value beyond the current environmental process. As currently proposed the methodology and results are likely subjective, qualitative, and ultimately speculative. Neither is it likely that the HIA process will result in any additional mitigation beyond what the ports already provide given the extensive list of regulatory requirements and port adopted mitigation programs, such as the SPBCAAP (San Pedro Bay Clean Air Action Plan), and the WRAP (Water Resources Action Plan)."


A quote from the Vice President, Pacific Merchant Shipping Association in a news item in The Cunningham Report about the US Environmental protection Agency's work on considering whether HIA should also become part of the set of assessments undertaken by developers.


Click here to go to the news item.

While understanding his underlying frustration at onerous and burdensome regulations (as he sees them) particularly in its potential to block further development, given the earlier post on shipping and its emissions I guess I would have to agree to disagree on the value of HIA in such contexts as those listed above. Plus HIA looks for both the positives and negatives and in this context would show both the benefits and costs to human health of port developments e.g. employment, wider economic regeneration and development, air pollution, noise, etc.

HIA of mining article: Of mines and men

A nice short article on the value of Health Impact Assessment in the context of mining projects in the Malaysian newspaper The Sun by Andrew MacKenzie of the International Council on Mining and Metals.

Click here to read the article.

My favourite quote:

"Companies should use health impact assessments with a simple goal in mind: to leave communities healthier than when they found them. A mine cannot be successful without a healthy local workforce and the support of the community in which it operates. Protecting the health of our neighbours around the world isn’t just good business. It’s also the right thing to do."
 
Disclosure: Salim led the writing of the ICMM 2010 guide on HIA. Click here to go to the ICMM HIA guide webpage.

Image courtesy of nanosmile through Wikipedia and the Wikimedia Commons.

US National Health Policy Forum Session on HIA

On the 3rd December 2010, the National Health Policy Forum, at George Washington University had a seminar on "HIA: What, Why, How, Who, Where?"

  Click here to go directly to the site.

	Health Impact Assessments: What, Why, How, Who, Where?
	Michele J. Orza, ScD (Coordinator)
	Summary: Increasingly, a wide range of people from economists to epidemiologists are taking a broad-based, comprehensive approach to improving the public’s health and working on many fronts simultaneously.  An important means for implementing this approach, often characterized as "health in all policies," is the health impact assessment (HIA). These assessments are intended to bring a health focus to policies, programs, and projects in other sectors, such as agriculture, energy, and transportation, where the effects of the proposed action on health might not be adequately considered—or considered at all.  HIAs are a vehicle for supporting policymaking intended to advance the public's health by making explicit the health effects of the various alternatives under consideration. This Forum session provided an introduction to health impact assessments, examined several examples and their effect on policy and health outcomes, and discussed future opportunities and challenges for this burgeoning health policy practice. Speakers:
	Aaron Wernham, MD, Director, The Health Impact Project, The Pew Health Group, The Pew Charitable Trusts; Catherine L. Ross, PhD, Director, Center for Quality Growth and Regional Development, Harry West Professor, School of City and Regional Planning, Georgia Tech College of Architecture; Suzanne K. Condon, MSM, Associate Commissioner for Health, Director, Bureau of Environmental Health, Massachusetts Department of Public Health Slides from the presentations by Dr. Wernham, Dr. Ross, and Ms. Condon are available for download (click on the names). Related materials:
	The Health Impact Project brief "Health Impact Assessment: Bringing Public Health Data to Decision Making" was distributed at the session. AcademyHealth also provides a brief, "Research Informing Policy: The Potential of Health Impact Assessments." And the Centers for Disease Control and Prevention's web page on Health Impact Assessment provides basic background and links to a variety of resources. See also other Forum products, including "High Hopes: Public Health Approaches to Reducing the Need for Health Care" (Background Paper No. 78, September 27, 2010); "Unusual Suspects: Focusing on Nonmedical Determinants to Improve the Nation's Health" (Forum Session, November 5, 2010); and "Getting Real: Data Sources, the Evidence Base, and Strategies for Improving the Health of Communities" (Forum Session, September 24, 2010).

Health impacts of shipping pollution have been 'underestimated'

This is an interesting Guardian article that I've only just come across on the underestimation of the health impacts of shipping (which of course ferries all the goods we want and need from oil and gas to electronics and food.

Read the full article by clicking here.

KEY POINTS:

• One giant ship can emit air pollution equivalent to 50 million cars.
• US academic research shows that pollution from the world's 90,000 cargo ships leads to 60,000 deaths a year in the US alone and costs up to $330bn per year in health costs from lung and heart diseases. The US Environmental Protection Agency estimates the buffer zone [of 230 miles], which could be in place by next year, will save more than 8,000 lives a year with new air quality standards cutting sulphur in fuel by 98%, particulate matter by 85% and nitrogen oxide emissions by 80%.
• Danish government environmental agency suggests that shipping emissions cost the Danish health service almost £5bn a year, mainly treating cancers and heart problems. A previous study estimated that 1,000 Danish people die prematurely each year because of shipping pollution.

KEY SHIPPING STATISTICS:

• The world's biggest container ships have 109,000 horsepower engines which weigh 2,300 tons.
• Each ship expects to operate 24hrs a day for about 280 days a year
• There are 90,000 ocean-going cargo ships
• Shipping is responsible for 18-30% of all the world's nitrogen oxide (NOx) pollution and 9% of the global sulphur oxide (SOx) pollution.
• One large ship can generate about 5,000 tonnes of sulphur oxide (SOx) pollution in a year
• 70% of all ship emissions are within 400km of land.
• 85% of all ship pollution is in the northern hemisphere.
• Shipping is responsible for 3.5% to 4% of all climate change emissions

Courtesy of Slashdot.com

Beauty is a part of healthy urban planning

One of the things I learned in medicine was that form follows function and that some of the most aesthetically elegant and beautiful biological objects, processes and organisms occur when physical biological structures are closely aligned to function.

Similarly, as a new report by  the UK Commission for Architecture and the Built Environment found, people want and need beauty in their physical environment - both built and natural. there is potentially innate aesthetic sensibility which is attracted to beautiful things (though these differ between individuals, communities and societies).

Check out the video and the series of essays and online discussions at the CABE website by clicking here or the links below.

• Beautiful Sheffield? video
• People and places: public attitudes to beauty.

Seven essays on beauty

• Beauty and public policy - Glenn Parsons
  
• Beauty, localism and deprivation - Irena Bauman
• The X factor: beauty in planning - Matthew Kieran
• Beauty and a love of life - Diana Athill
• Beauty: value beyond measure? - Hasan Bakhshi
• Beauty: a short history - Alan Powers
• Beauty, well-being and prosperity - Bonnie Greer

Check out the other useful healthy urban planning related work of CABE at www.cabe.org.uk

The advocacy of science and the science of advocacy in harm reduction

This is an excellent lecture and well worth reading in full. The download link is provided below. It raises issues that HIA practitioners also grapple with in their interactions with policy and decision-makers. Can HIA practitioners play a role in developing the science of advocacy? At a lecture yesterday at the London School of Hygiene and Tropical Medicine (where I did my MSc and PhD) Prof. Stimson made the case for a revolution in Public Health, shifting the focus from the 'bad behaviour' of individual to the 'bad  behaviour' of policy makers who ignore the powerful scientific evidence  behind harm reduction

Prof. Stimson was a member of the first group of researchers to evaluate needle exchange programmes in the United Kingdom in the mid 1980´s at the beginning of the HIV/AIDS epidemic. He was also on the Advisory Council on the Misuse of Drugs committee that designed the United Kingdom harm reduction response. That was a public health success, and emulated in other countries. Stimson says that public health policy requires a new revolution that starts to look at why policy makers continue to behave “badly” and ignore all the consistent scientific evidence presented to them when it came to decision making. “For too long, public health has focused on the powerless, trying to get drug users, and drinkers and smokers to change their risky behaviour,...Why are there so many studies of the knowledge, attitudes and behaviours of drug users and so few studies of the knowledge, attitudes and behaviours of policy makers when it is the behaviours of the latter that are a much more important problem?” He argues there are a number of reasons behind this “bad” behaviour of policy makers. Key among them is that drugs policy has to fit with the current ‘big political idea’. In the lecture Prof. Stimson traces the history of science and advocacy in the field of Harm Reduction from his early days as a researcher, his time as a consultant to the World Health Organisation through to his period as head of the International Harm Reduction Association. He argues that science has been important in the development of harm reduction policy and cite examples where its take up has been both broadly implemented in many countries (drink driving, needle exchange) and marginalised (alternatives to smokeable tobacco). He concludes by suggesting that here have been major successes in advocating for harm reduction, but that the science of advocacy is underdeveloped. Click here to download the full lecture transcript Click here to go to the Conference Consortium home page

Health Impact Assessment in the Asia Pacific: Special Issue of EIA Review

A special issue of Environmental Impact Assessment Review on Health Impact Assessment in the Asia Pacific has been released - just in time for the HIA2010 Third Asia Pacific HIA Conference in Dunedin.

The articles in the issue are listed below. They're drawn from presentations at the First Asia Pacific HIA Conference in Sydney in 2007 and the Second Asia Pacific HIA Conference in Chiang Mai in 2009.

Please let me know if you have any trouble accessing the articles.

HIA in the Asia Pacific

Editorial: Health Impact Assessment in the Asia Pacific
Ben Harris-Roxas
http://dx.doi.org/10.1016/j.eiar.2010.10.001

Articles relating to HIA as a field

1. Harris-Roxas B, Harris E. Differing forms, differing purposes: A typology of health impact assessment. http://dx.doi.org/10.1016/j.eiar.2010.03.003

2. Morgan RK. Health and impact assessment: Are we seeing closer integration? http://dx.doi.org/10.1016/j.eiar.2010.03.009

3. Pennock M, Ura K. Gross national happiness as a framework for health impact assessment. http://dx.doi.org/10.1016/j.eiar.2010.04.003

Articles on HIA programs

4. Harris P, Spickett J. Health impact assessment in Australia: A review and directions for progress. http://dx.doi.org/10.1016/j.eiar.2010.03.002

5. Cameron C, Ghosh S, Eaton SL. Facilitating communities in designing and using their own community health impact assessment tool. http://dx.doi.org/10.1016/j.eiar.2010.03.001

6. Kang E, Lee Y, Harris P, Koh K, Kim K. Health impact assessment in Korea. http://dx.doi.org/10.1016/j.eiar.2010.02.005

7. Kwiatkowski RE. Indigenous community based participatory research and health impact assessment: A Canadian example. http://dx.doi.org/10.1016/j.eiar.2010.02.003

8. Wu L, Rutherford S, Chu C. The need for health impact assessment in China: Potential benefits for public health and steps forward. http://dx.doi.org/10.1016/j.eiar.2010.03.004

Articles on specific HIAs

9. Spickett JT, Brown HL, Katscherian D. Adaptation strategies for health impacts of climate change in Western Australia: Application of a Health Impact Assessment framework. http://dx.doi.org/10.1016/j.eiar.2010.07.001

10. Inmuong U, Rithmak P, Srisookwatana S, Traithin N, Maisuporn P. Participatory health impact assessment for the development of local government regulation on hazard control. http://dx.doi.org/10.1016/j.eiar.2010.03.008

11. Gunning C, Harris P, Mallett J. Assessing the health equity impacts of regional land-use plan making: An equity focussed health impact assessment of alternative patterns of development of the Whitsunday Hinterland and Mackay Regional Plan, Australia. http://dx.doi.org/10.1016/j.eiar.2010.03.005

12. Tugwell A, Johnson P. The Coffs Harbour 'Our Living City Settlement Strategy' Health Impact Assessment. http://dx.doi.org/10.1016/j.eiar.2010.02.004

Americans less healthy than the English but live as long or longer

An article in Medical Daily on some research by the RAND corporation in the USA and the Institute for Fiscal Studies in England found that:

Click her to go directly to the Medical Daily article.


The study found that both disease prevalence and the onset of new disease were higher among Americans for the illnesses studied - diabetes, high-blood pressure, heart disease, heart attack, stroke, chronic lung diseases and cancer. Diabetes and cancer rates were around twice as high in the United States as in England.


However, death rates among Americans were about the same in those aged 55-64 years and lower for those in their 70s as the English research participants.


Two possible explanations have been suggested:
1) The diseases studied result in higher numbers of deaths in England than in the United States. 
2) English participants were diagnosed at a later stage in the disease process than Americans.


The implication being that there is higher quality medical care in the United States than in England for the chronic illnesses studied leading to less deaths from these chronic illnesses.


The study also investigated the relationship between the financial resources of individuals in both countries and how soon they would die in the future.The researchers found that poorer people are more likely to die sooner and consider that the causal pathway between health and wealth is that poor health leads to a reduction in household wealth, rather than being poor causes one's health to decline. Researchers found that the substantial changes in wealth that occurred in the years 1992 and 2002 in the United States through increases in stock prices and housing prices did not alter the probability of subsequent death.

My thoughts are that this makes sense, it is poor people's reduced ability to withstand life stresses that lead to them ageing more quickly and becoming less healthy over time compared to richer people. The reduction in household wealth therefore links to a reduction in resilience or buffering of life stress i.e. that less money in the future means less ability to withstand personal, family crises from the mundane a household repair to future illnesses and the ability to pay for holidays, education and other quality of life improving material goods and services.

It also confirms something that Ben has written about, that healthcare is an important determinant of health and should not be forgotten in low and high income country contexts.


Have I got that right? Or have I missed something?

HIAs Sought for Study: Australia & New Zealand 2005-2009

There a piece over on Croakey about health impact assessment.

It's partly about the HIA session at the US APHA Conference. It also includes a call for help in finding HIAs in Australia and New Zealand conducted between 2005 and 2009 for a new study I'm involved in.

If you know of any that aren't on the list below I'd love to hear from you.

The study's looking at HIAs conducted in Australia or New Zealand between 2005-2009 that have reports available.

Though this study is focused on HIAs, rather than environmental impact assessments (EIAs), we’re still interested in interested in any EIAs that have discrete health sections. I know that in many EIA reports health is integrated throughout, but if there’s any that you think have had substantive health component, we’d certainly be interested in taking a look at them. The issue of how health is considered within EIA is of course an important one, and we’re currently developing separate research proposals that address this issue specifically.

NSW

• Sydney West Area Health Service Parramatta City Council HIA 2009
• Equity Focused HIA of the Review of Goodooga Health Service 2009
• Good for Kids Good For Life Equity Focused Health Impact Assessment 2008
• Health Impact Assessment of Lithgow City Council’s Strategic Plan 2008
• Oran Park and Turner Road Health Impact Assessment 2008
• Coffs Harbour Our Living City Settlement Strategy Health Impact Assessment 2007
• Greater Western Sydney Urban Development Health Impact Assessment 2007
• Health Impact Assessment of the Redevelopment of Liverpool Hospital 2007
• Health Service Realignment Health Impact Assessment 2007
• Bungendore health impact assessment: urban development in a rural setting 2007
• Greater Granville Regeneration Strategy Health Impact Assessment 2006
• Health Impact Assessment of the Wollongoing Foreshore Precinct Project 2006
• Indigenous Environmental Health Worker Proposal HIA 2006
• Rapid Equity Focused HIA of the Australian Better Health Initiative: Assessing the NSW components of priorities 1 and 3 2006
• Healthy Urban Planning: Recommendations from the NSW HIA project 2006
• Health & Social Impact Assessment of the Lower Hunter Regional Strategy 2006
• Ban on commercial fishing in the estuarine waters of New South Wales, Australia: Community consultation and social impacts 2006

QLD

• Assessing the health equity impacts of regional land-use plan making: An equity focussed health impact assessment of alternative patterns of development of the Whitsunday Hinterland and Mackay Regional Plan, Australia 2009
• Flinders Street Redevelopment Project 2008
• Gold Coast Council Landfill HIA 2009
• Health and Social Impact Assessment South East Queensland 2005

SA

• HiAP Water Security Health Lens 2009
• Equity Focused HIA of the South Australian ABHI School and Community Initiative 2008
• Preliminary examination of the population health impacts of SASP targets including labour participation 2007

VIC

• Leopold Strategic Footpath Network Health Impact Assessment 2008
• Hobson HIA 2008
• Drought Mallee Region HIA 2007
• Health Impact Assessment in the East Gippsland Shire Council 2005
• A matter of equity — Case Study Frankston City Council 2005
• School closure—what is the effect on health? 2005

WA

• Health Impacts of Climate Change: Adaptation strategies for Western Australia 2007
• The Role of Stakeholders in HIA: A Landfill Site and Housing Development in Mundijong, Western Australia 2007

NZ

• Whakawateatia Hawke’s Bay District Health Board: Health Impact Assessment on the proposed Air Quality Plan Change 2009
• Wairarapa Non-fluoridation of water WOHIA 2009
• Makoura Responsibility Model 2009
• Auckland Regional Transport Strategy HIA 2009Health Impact Assessment on the draft Wairoa District Council Waste Management Activity Management Plan 2009
• HIA of Flaxmere Town Centre, Urban Design Framework 2009
• HIA Implementation of Oral Health Strategy Location of a Community Clinic in Flaxmere 2009
• An Age-Friendly Community: Shaping the future for Waihi Beach HIA 2009
• Manukau Built Form and Spatial Structure Plan HIA Report 2008
• Christchurch South West Area Social and Health Assessment 2008
• McLennan Housing Development, Papakura HIA 2008
• Proposed Liquor Restriction Extensions in North Dunedin HIA 2008
• Ranui Urban Concept Plan HIA 2008
• Tokoroa Warm Homes Clean Air Project: Health and Well-being Impact Assessment 2008
• Health Impact Assessment of Central Plains Water Scheme 2008
• Health Impact Assessment of the Greater Wellington Regional Policy Statement Regional Form and Energy Draft Provisions 2008
• Kerikei-Waipapa Draft Structure Plan 2007
• Greater Christchurch Urban Development Strategy Health Impact Assessment 2006
• Greater Wellington Regional Land Transport Strategy Health Impact Assessment 2006
• Healthy, Wealthy and Wise: A Health Impact Assessment of Electricity Scenarios for New Zealand 2005-2050 2006
• Mangere Let’s Beat Diabetes Health Impact Assessment. 2006
• Social Impact Assessment of the Draft Nelson City Council Gambling Policy 2006
• Avondale’s Future Framework rapid HIA: final report 2005
• Hastings Graffiti HIA 2005
• Wairau Road Widening HIA 2005

Minimum Elements & Practice Standards for Health Impact Assessment

From the American Practice Standards subgroup:

The HIA of the Americas Practice Standards subgroup is excited to release an updated version of the “Minimum Elements and Practice Standards for Health Impact Assessment (HIA).”

Minimum Elements answer the question of “what essential elements constitute an HIA” as distinct from Practice Standards, which answer the question, “how to best conduct an HIA.”

Overall, the hope is to translate the values underlying HIA along with key lessons from HIA practice into specific standards for practice for each phase of the HIA process.

The document can be found on Human Impact Partners' website, at
http://www.humanimpact.org/news/24-hiapracticestandards

The most interesting aspect to me is the new section on what constitutes the essential characteristics of an HIA:

1. Is initiated to inform a decision-making process, and conducted in advance of a policy, plan, program, or project decision;
2. Utilizes a systematic analytic process with the following characteristics:
   2.1. Includes a scoping phase that comprehensively considers potential impacts on health outcomes as well as on social, environmental, and economic health determinants, and selects potentially significant issues for impact analysis;
   2.2. Solicits and utilizes input from stakeholders;
   2.3. Establishes baseline conditions for health, describing health outcomes, health determinants, affected populations, and vulnerable sub-populations;
   2.4. Uses the best available evidence to judge the magnitude, likelihood, distribution, and permanence of potential impacts on human health or health determinants;
   2.5. Rests conclusions and recommendations on a transparent and context-specific synthesis of evidence, acknowledging sources of data, methodological assumptions, strengths and limitations of evidence and uncertainties;
   
3. Identifies appropriate recommendations, mitigations and/or design alternatives to protect and promote health;
4. Proposes a monitoring plan for tracking the decisionʼs implementation on health impacts/determinants of concern;
5. Includes transparent, publicly-accessible documentation of the process, methods, findings, sponsors, funding sources, participants and their respective roles.

UNSW HIA eNews Issue 24: Health impact assessment news & resources

The 24th issue of the UNSW Health Impact Assessment eNews is now available.

In this issue:

• HIA2010 Third Asia Pacific Health Impact Assessment Conference
• Health impacts of the Gulf of Mexico Oil Spill
• Five Years of the HIA Blog
• HIA of a Wind Farm
• An Asia Pacific Health Impact Network
• If social support is so important for our health, why doesn’t it get more attention?
• Quantifying the health impacts of policies
• YouCommNews: A new media experiment
• HIA Round-Up

This issue also includes the latest IUHPE HIA Global Working Group Round-Up, with more than 100 links to HIA-related news, resources, events and training. It's at the back of the eNews.

Unintentional side-effects of local renewable electricity production

An interesting point from a VentureBeat blog post "Smart grid could mean your energy bill goes up". Click here to go to the original post.

It points out that a homeowners who can afford solar panels and wind turbines create their own self-sufficient local energy and storage clusters that this may mean that many residents and even whole neighbourhoods disappear from the current national grids meaning that energy utilities will have to charge the remaining customers more.

This is likely to mean that it will be the less well off who a) don't benefit from the tax incentives and savings that local renewable energy systems may bring as well as b) paying more for their electricity from the major energy utilities.

So while sustainable energy use increases health and social inequalities may widen.

WHO/Europe concludes mission on health impact of sludge spill in Hungary

A four-day WHO expert field mission to Hungary concluded on 16 October by making recommendations to minimize the short- and long-term health impact of a sludge spill at an alumina plant of Magyar Alumínium Zrt. (MAL Zrt.), Ajkai Timfoldgyar in the town of Ajka, and to prevent similar events with potential transboundary effects.

Acute health risk diminished

The spill caused 9 deaths and over 150 injuries, mostly due to drowning and chemical burns from the corrosive effect of the red mud. It destroyed or severely damaged over 300 houses in the villages of Kolontár, Devecser and Somlóvásárhely in western Hungary. At the affected sites, measures were promptly taken to neutralize the corrosive mud and reduce the immediate danger of exposure. As the sludge has receded and its pH decreased, the risk of direct health damage from contact has been substantially reduced.

Focus on resident population and rescue workers

As the recovery and rehabilitation phase is under way, particular attention now needs to be paid to preventing potential health risks to the population of the affected areas, and the nearly 4000 rescue workers and volunteers involved in the clean-up. Exposure to the mud by contact, inhalation or ingestion should be minimized. This requires completing the removal of the sludge from the affected areas (particularly houses), monitoring the concentration of outdoor and indoor air pollutants, and providing the population and first-line workers with clear advice on protecting themselves. As the psychological effects of the disaster are recognized, a specialized team of Hungarian psychologists is providing support on site to people who have been evacuated, suffered injuries and/or deaths in their families, and/or sustained losses of and damage to property. This need will persist for both the short and medium terms.

No danger to health from drinking-water

Importantly, the quality of drinking-water supplied to the affected areas has remained adequate and poses no health risk to the community. Continued monitoring of outdoor and indoor air, drinking-water and the quality of soil and food production will remain essential to assess the risk of exposure, particularly to heavy metals, in the medium and long terms and to take action as required.

No risk from international spread

Great effort has been dedicated to preventing the further spread of the spill to the river Danube, as this could result in environmental damage to neighbouring countries. The information available indicates that the quality of Danube water has remained substantially unaffected. Nevertheless, with some 150 waste reservoirs located along the river, the spill highlights the need for comprehensive mapping and assessment of these installations, their resilience to extreme weather events and to any risk of contamination of soil and ground water from poorly isolated reservoirs. Risk from currently used and heritage industrial sites is common to many countries in the lower Danube. Existing policy instruments, such as the Protocol on Water and Health, can support action to identify and remediate particularly contaminated sites with a potential to harm health through water contamination.

Extract from WHO website. Click here to go to the webpage.

11th International HIA Conference - Abstract Submissions Deadline 15th Dec 2010

"In times of crisis, healthier ways"

The XIth International HIA Conference will take place on 14th-15th April 2011 in Granada, Spain at the Andalusian School of Public Health.

Abstracts are now being accepted, so if you have an interesting HIA story to tell whether at local, regional, national or international levels then get writing and submit you 300 word abstract for an oral or poster presentation.

Submissions are online from the conference website at:

http://www.hiainternationalconference.org/index.php/en 

Abstracts are welcomed in the four main conference topics:  

Topic 1. The role of HIA in times of crisis

How HIA can help reconsider the foundation of the prevailing development model, to include health as a core value for the wellbeing of the population wellbeing in  public policies, and to effectively address health equity. 

Topic 2. Embedding HIA in the decision making process to promote HiAP

How HIA can be mainstreamed to promote healthier public policies, as well as the opportunities that emerge from the new public health laws currently being developed in many countries at a national and regional levels. 

Topic 3. HIA methodology

What methodologies alongside solid evidence-based knowledge can facilitate the effective integration of HIA into policy-making processes whilst having a strong community perspective.

Topic 4. Sectorial experiences. HIA is being increasingly used in a variety of sectors and activities

Current HIA practice in urban planning, transport, regeneration projects, etc. and new emerging areas for HIA development.  

Miniature Stoke: a cool way of showing a community profile

The purpose of mini Stoke is to bring to life a number of important ‘facts’ about peoples health and well-being in Stoke-on-Trent. It describes a moment in time, and aims to tell the story of what Stoke-on-Trent would be like if it was made up of one hundred people.

It is hoped that Miniature Stoke-on-Trent will be used by a whole range of people from community groups, local councillors, schools, colleges, universities and local employers to spark conversations about life in Stoke-on-Trent and to share people’s experiences of living, working and visiting the city.

Check out the Miniature Stoke website at: www.miniaturestoke.co.uk

Check out the Stoke-on-Trent Healthy City website at: www.healthycity-stoke.co.uk

Check out the Miniature Glasgow website at: www.miniatureglasgow.com

HIA: conjecture, editorializing, data gaps and assumptions

All the above words have been used to describe the recent draft HIA report for the Garfield County Battlement Mesa natural gas extraction project.

Check out the Glenwood Springs Post Independent article.

Most experienced HIA practitioners will have come across similar statements on their HIAs (from all kinds of stakeholders including communities and proponents). Making judgements under uncertainty and trying to quality assure these judgements is one of the most difficult aspects of doing good HIAs.

There are no easy answers but peer review both internal to the organisation doing the HIA as well as from external HIA practitioners and scientists  (something suggested for this HIA) and having an explicit and detailed report can both help.

It will be interesting to see how this plays out.

Click here to download the draft Battlement Mesa HIA Report.

Four new US HIAs looking at transit, energy & nutrition policies

From a Health Impact Project Press Release

WASHINGTON — The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, today announced nearly $400,000 in grants to four organizations to conduct health impact assessments (HIAs). The assessments will identify and address potential and often overlooked health implications of policy proposals including farm-to-school food legislation, energy development, smart-metering technology for electric utilities and urban transportation plans.

The projects, to be conducted in Georgia, Illinois, Kentucky and Oregon, are at the leading edge of a growing movement in the United States in which governments, non-profit groups and other organizations use HIAs to help ensure that decision makers craft public policies and projects that avoid unintended consequences and unanticipated costs. These four awards bring the Health Impact Project’s investments in this field to more than $1.5 million for 2010.

“An HIA identifies the benefits and consequences of government decisions that fall outside the traditional scope of public health,” said Aaron Wernham, M.D., director of the Health Impact Project. “These grants will give policy makers powerful tools to weigh the pros and cons of a proposal, identify health opportunities and tradeoffs and ensure that their decisions achieve the greatest benefits for people in affected communities.”

The newly-funded HIAs are part of a diverse portfolio of projects occurring across the country. Currently, through funding from the Health Impact Project, HIAs are being conducted on proposals for public transit systems; a county agricultural plan; a land-use plan to redevelop an abandoned factory site; proposed state “cap-and-trade” regulations and a state budget process. It is expected that a second round of funding and call for proposals will be released in early 2011.

“Some of the decisions that have the greatest impact on our ability to be healthy are made by leaders outside the fields of health and health care,” said Michelle A. Larkin, J.D., M.S., R.N., senior program officer and director of the public health team at the Robert Wood Johnson Foundation. “HIAs give leaders outside the health sector the information they need to factor health into a decision and can help them create safer, healthier communities throughout the United States.”

The four projects announced today by the Health Impact Project include:

• The first-ever HIA on a major metropolitan transportation and comprehensive growth plan will be led by the Center for Quality Growth and Regional Development (CQGRD) at the Georgia Institute of Technology's College of Architecture. The Center will examine how PLAN 2040—which is being conducted by the Atlanta Regional Commission, the local intergovernmental coordination agency—will impact a range of health issues, such as injury and asthma rates, and the risks of obesity and diabetes. PLAN 2040 integrates multiple aspects of regional planning, including transportation and land use; housing; greenspace; and water and air quality through the year 2040. A final HIA is expected in September 2011.
• The study by the Green River District Health Department in Owensboro, KY, is the first to address the overall health impacts that may result from a coal gasification project. Rather than burning coal, gasification techniques utilize a technology that converts coal into a substitute or synthetic natural gas. Together, the proposed plants—Cash Creek, Kentucky NewGas and Indiana Gasification—have the potential to affect nearly 500,000 people living nearby. The HIA will examine important health tradeoffs that could be associated with the planned projects. These include the benefits they could bring to the health of area residents as a result of employment opportunities and subsequent increase in income, health care access and local tax revenue, as well as the risks posed by any emissions produced. This HIA will provide practical recommendations for actions that could be taken to maximize the benefits and minimize any potential harm from these projects. The HIA’s recommendations will be included in a final report scheduled to be completed by February 2011, and can inform lawmaker’s decisions concerning these plants.
• “Smart meters” may help electric utilities improve the reliability of the power grid and encourage conservation during peak-demand periods, but the health risks and benefits of this technology have not yet been studied. That is why the National Center for Medical-Legal Partnership at Boston Medical Center plans to produce a unique HIA of a pilot program run by Illinois’ largest electric utility, Commonwealth Edison. The assessment will measure the health effects of this technology in western metropolitan Chicago, in particular how these innovations could protect customers from potentially life-threatening exposure to heat or cold. The HIA also will look at the impact of energy prices on vulnerable populations such as the elderly, low-income or disabled, and the potential for this technology to increase or decrease the utility’s quality of service. The findings, expected in mid-2011, will become a model for understanding the potential impacts of widespread implementation. The grantee and Chicago’s non-profit Citizens Utility Board will collaborate on the HIA, disseminate the findings and make recommendations based on what was learned from the assessment to the Illinois Commerce Commission, the regulatory body monitoring the pilot program.
• Upstream Public Health, a public policy non-profit based in Portland, OR, will conduct a novel HIA of proposed legislation in Oregon that would provide state funds to purchase locally-grown foods for schools and set up school teaching gardens. The lessons learned from this project could be applied to other food and agricultural policies being considered by states across the nation. The goal of the HIA is to inform state lawmakers and examine how the proposed law would impact child nutrition in public schools and the economic health of rural communities. The analysis will examine how new purchases of local foods, especially fruits and vegetables, will impact a variety of diet-related diseases such as diabetes and obesity. In addition, the HIA will consider how increased local food purchasing could best benefit the health and well-being of economically-depressed rural communities. The full report is expected to be available in March 2011.

To learn more about HIAs, how they work, previously funded projects and the goals of the Health Impact Project, please visit www.healthimpactproject.org.

A Heavy Burden: the individual costs of being overweight and obese in the USA

This is an interesting research report on some key financial costs of being overweight and obese. A summary is presented below:

Introduction
More than 60% of the United States population is overweight or obese, and if the current trajectory continues, 50% of the population will be obese by 2030. There is no question that being obese or overweight, is more costly than being of normal weight. Using existing literature, we have detailed the costs incurred due to overweight and obesity that affect working-age adults at the individual level.

What is the cost of being obese in America?
The overall, tangible, annual costs of being obese are $4,879 for an obese woman and $2,646 for an obese man. The overall annual costs of being overweight are $524 and $432 for women and men, respectively. For both genders, the incremental costs of obesity are much higher than the incremental costs of being overweight.

Adding the value of lost life to these annual costs produces even more dramatic results. Average annualized costs, including value of lost life, are $8,365 for obese women and $6,518 for obese men.
We only have a partial approximation of the cost of obesity for individuals.

The picture we have created is only a partial look at the individual costs related to obesity. Existing literature provides information on health- and work-related costs, but with the exception of fuel costs, there is no published academic research that gives us insight into consumer-related costs, such as clothing, air travel, automobile size or furniture. Anecdotal evidence suggests these costs could be significant.
How obese you are matters.

Where it was possible to break down the costs by degrees of obesity, it is clear the incremental costs of morbid obesity are much higher than those of moderate obesity. Total incremental costs for obese women are more than nine times higher than those for overweight women. For obese men, the incremental costs are six times higher than for overweight men.

The cost drivers are different for the overweight and the obese.

• For those who are overweight, the main cost drivers are direct medical costs – 66% for women and 80% for men. 
• Conversely, while direct medical cost is the primary driver of costs for obese men, only one-third of the overall costs for obese women are medical costs.
• Obese women are disproportionately affected by job-related costs.
• The overall, annual, incremental costs are significantly higher for obese women than for obese men. The difference is mostly the result of lost wages for obese women.

Click here to download the report.

Click here to go to the article on the George Washington University website.

Lifestyle versus socio-economic causes of the rise in obesity

In HIA we have tended to focus on the physical environmental factors that have reduced physical activity and access to fresh fruit and vegetables - the so-called 'obesogenic environment'. We generally focus much less on the way society is structured and how that might affect levels of obesity and the often subconscious worldviews embedded in the advocacy of certain forms of health interventions.

Farming Pathogens has an interesting article titled 'How Mayor Bloomberg causes obesity'.

The article argues that lifestyle focused interventions e.g. the focus on making welfare recipients eat healthily by not allowing them to buy 'junk' food using food vouchers ignores the socio-economic context within which health choices are made and how 'stressful environments' create the conditions for people to almost be 'self-medicating' on sugar and salt.

The Contribution of HTA, HNA, and HIA to the Assessment and Translation of Technologies in the Field of Public Health Genomics

The European Union has named genomics as one of the promising research fields for the development of new health technologies.

Major concerns with regard to these fields are, on the one hand, the rather slow and limited translation of new knowledge and, on the other hand, missing insights into the impact on public health and health care practice of those technologies that are actually introduced.

This paper aims to give an overview of the major assessment instruments in public health [health technology assessment (HTA), health needs assessment (HNA) and health impact assessment (HIA)] which could contribute to the systematic translation and assessment of genomic health applications by focussing at population level and on public health policy making. It is shown to what extent HTA, HNA and HIA contribute to translational research by using the continuum of translational research (T1–T4) in genomic medicine as an analytic framework. The selected assessment methodologies predominantly cover 2 to 4 phases within the T1–T4 system. HTA delivers the most complete set of methodologies when assessing health applications. HNA can be used to prioritize areas where genomic health applications are needed or to identify infrastructural needs. HIA delivers information on the impact of technologies in a wider scope and promotes informed decision making. HTA, HNA and HIA provide a partly overlapping and partly unique set of methodologies and infrastructure for the translation and assessment of genomic health applications. They are broad in scope and go beyond the continuum of T1–T4 translational research regarding policy translation.


To go to the pay-per-view article click here.

Evidence-based health impact assessment (EBHIA): a situation report (from the UK)

This research was carried out to ascertain the different types and sources of evidence commonly applied to the Health Impact Assessment (HIA) process in the United Kingdom; and to also examine the factors that influence the derivation and usage of the different types of evidence.

A questionnaire survey of 52 HIA practitioners who had conducted a total of 103 HIAs over a 3-year period was carried out, followed by semi-structured interviews of 11 practitioners to gain deeper insights into the questionnaire findings.

Ten different sources of evidence were seen to have been applied to the HIA process. Literature review was discovered to be the most commonly utilized source of evidence, having been used by 37 out of 52 practitioners (71.2%) and in 83.5% of the 103 HIAs. Engagement with local residents was second in terms of usage by practitioners (69.2%) and expert opinion was third, having been used by 67.3% of respondents. Other sources of evidence included completed HIA reports, survey, modelling and Delphi exercises. The findings point to efforts to ensure that predictions are grounded on robust sources of evidence, although several issues need to be addressed in the pursuit of evidence-based HIA (EBHIA).

To go to the pay-per-view article click here.

Theory in a Nutshell

The use of theory in the planning and implementation of health promotion programs will more reliably produce positive outcomes. 

Following on from the success of the second edition, 'Theory in a Nutshell 3rd Ed' explores the main theoretical concepts and models in health promotion and explains the significance, practical application and impact of different theories on the individual, community and organization. 

This edition includes concise reviews of established theories, such as social cognitive theory and health belief model, as well as expanding on new developments in the field including evidence-based policy making and health impact assessment. Thoroughly revised and updated, the book maintains the accessible style suitable for public health practitioners, health promotion and health education specialists, epidemiologists and social policy makers, as well as students of public health and health promotion.

Original Source: http://www.healthypeople-betterpeople.info/

Developmental milestones in children's environmental health

Interesting editorial in the latest issue of Environmental Health Perspectives. Below are the extracts that I liked that has relevance for HIA [emphasis added and phrases in square brackets]:

"...In the early 1900s, the environment was already well understood to  be an important contributor to health, and its importance was routinely taught to [medical and nursing] students. Think of Florence Nightingale’s 6 Ds of disease: dirt, drink (clean drinking water), diet, damp, drafts, and drains  (proper drainage and sewage systems). With the advent of high-tech  medicine, however, these fundamentals began to receive short shrift in  graduate education. At the same time, the house call - a home visit that  allowed the physician to view the environment in which the patient  lived - became increasingly rare, and doctors’ visits began to take place  in the confines of modern offices or hospitals, far removed from the  day-to-day surroundings of the family. Over time, the environment  became “invisible” to the medical practitioner.
...Why has it been so difficult to move from knowing to doing?  First, many of the decisions affecting children are made not by those  in the health sector, but by our professional colleagues in the agriculture, education, energy, housing, mining, and transportation sectors. Just as “men are from Mars and women are from Venus,” it seems  as if professionals in each of these sectors are from different planets.  Although we may speak the same language, we rarely have more  than a cursory understanding of the forces that shape one another’s decisions and other considerations...

Professionals in the health sciences may  work alongside professionals in other sectors, but we are absorbed in our own activities and usually have little interaction outside them. Instead of sitting at the table with urban planners, housing specialists, and energy experts when health professionals are planning an approach to a child health problem such as asthma, we usually move forward to design a study, implement it, analyze the results, and then present it as a fait accompli to our colleagues in other economic sectors, and hope that they will find it useful.

...This is not the ideal way to engage them. We medical professionals  need to fully engage with other sectors as we launch our attempts to  find solutions to child health problems. Major breakthroughs are likely  to occur in protecting children from hazards in the environment only  when we establish strong working relationships with those who haven’t  been trained as we have and who don’t think as we do. One tool that  helps different sectors to interact is Health Impact Assessment, pro- moted by the WHO (2010b) and by many countries including the  United States. Health Impact Assessment helps decision makers make  choices about alternatives and improvements to prevent disease/injury  and to actively promote health. A recent White House Task Force on  Childhood Obesity report recommends that communities consider  integrating Health Impact Assessment into local decision-making  processes before undertaking any major new development or planning  initiative (White House Task Force on Childhood Obesity 2010."

Click here to go to the October 2010 Table of Contents.

Click here to download the article as a PDF.

Image Source: Salim Vohra

HIA sessions at the APHA Annual Meeting & Exposition - Nov' 6-10, 2010

The American Public Health Association (APHA) Annual Meeting and Exposition will host several sessions and talks related to health impact assessment.

These look very exciting and I'm very tempted to go! The only thing holding me back is the sustainability of flying to the US for a only a few days. What the examples below do show is the variety and depth of HIA work that is going on in the USA.

Health Impact Assessments: A Tool for Social Justice

• Community Health Assessment via Social Determinants and GIS: Informing Policy for Community Health Equity
• Incorporating Health Impact Assessment into the I-710 Freeway Expansion Decision-Making Process
• "Impact" in Health Impact Assessments: Effectiveness of HIAs as a Decision-Making Tool (Presented by Aaron Wernham, director of the Health Impact Project)
• Using Health Impact Assessment to Improve Health Outcomes Associated with Housing Development

Health Impact Assessment: A Decision Making Tool to Enhance Social Justice

• Health Impact Assessment in the U.S.: Bridging research and policy to address the determinants of health and health disparities (Presented by Aaron Wernham, director of the Health Impact Project)
• An Evaluation of Efforts to Raise Human Health Assessment in the Environmental Impact Assessment Process
• Health Impact Assessment in the National Environmental Policy Act: Leveraging Resources across Federal Agencies for Environmental Health and Informed Decision Making
• Use of Health Impact Assessment to Help Inform Decision Making Regard Natural Gas Drilling Permits in Colorado
• Balancing equity, Assessing health impacts, Ensuring effectiveness

Strategies Towards Positive Health Outcomes Through Community Health Planning, Partnership, Advocacy , and Policy Change

• Health Impact Assessment Capacity Building in Wisconsin

Everyone Gets Sick: A Rx for Policy Remedies Targeting the Workplace

• Paid Sick Leave as Public Health Policy: A Health Impact Assessment of the California Healthy Families, Healthy Workplaces Act

Communities Shaping Policy

• Building Policy Capacity Through a Community-Based Health Impact Assessment

Public Health Strategies for Health Promotion

• Gambling on the Health of the Public: A Health Impact Assessment for an Urban Casino
• Health Impact Assessment and/of City Council Policy: Opportunities to Address Social Determinants of Health in Baltimore

Environmental Contaminants and Public Health

• Health Impact Assessment as a Tool for Assuring Social Justice Regarding Interventions Implemented on Populations

Global trade, local impacts, and environmental justice challenges

• Public Health through Public Participation: Reducing Impacts from the Largest Freeway Expansion Project in the U.S.

Source: Health Impact Project

Climate Change: a summary of the science

The UK's Royal Society has produced a new short summary guide to climate change. This updates an earlier guide and highlights key areas of debate as well as consensus on climate change.

The guide's key conclusions are [Bold emphasis added]:

"There is strong evidence that changes in greenhouse gas concentrations due to human  activity are the dominant cause of the global warming that has taken place over the last  half century. This warming trend is expected to continue as are changes in precipitation over the long term in many regions. Further and more rapid increases in sea level are likely which will have profound implications for coastal communities and ecosystems.

It is not possible to determine exactly how much the Earth will warm or exactly how the  climate will change in the future, but careful estimates of potential changes and  associated uncertainties have been made. Scientists continue to work to narrow these  areas of uncertainty. Uncertainty can work both ways, since the changes and their  impacts may be either smaller or larger than those projected.

Like many important decisions, policy choices about climate change have to be made in  the absence of perfect knowledge. Even if the remaining uncertainties were substantially resolved, the wide variety of interests, cultures and beliefs in society would  make consensus about such choices difficult to achieve. However, the potential impacts  of climate change are sufficiently serious that important decisions will need to be made.  Climate science – including the substantial body of knowledge that is already well  established, and the results of future research – is the essential basis for future climate  projections and planning, and must be a vital component of public reasoning in this  complex and challenging area."

More details of the guide can be found at http://royalsociety.org/climate-change-summary-of-science/

Download the guide directly by clicking here.

Zotero: browser based citation manager soon supporting Firefox, Chrome, Safari and Internet Explorer

I tried Zotero a while back after Ben suggested it (I'm sure it was you Ben) but couldn't get into it. However, Zotero has launched 'Zotero Everywhere' and now supports all the major browsers (except Opera)

As with the majority of online services it follows a freemium model i.e. it is free to store 100MB after which it costs $20 a year for 1Gb, $60 per year for 5Gb and so on.

I think I will give it another go. There is also another similar online app called Mendeley which is also worth checking out.

Zotero can be found at www.zotero.org

Mendeley can be found at www.mendeley.com

If you use either of these let us know whether you have found them useful or not.

Our Water Future: Not just less water, the pipes will fail too

This post originally appeared at Healthy Democracy.

Shifts in spatial patterns of relative human water security threat after accounting for water technology benefits. Source: doi:10.1038/nature09440

The BBC has an interesting report that highlights that it's not just global warming-related changes to rainfall that threaten global water supplies, it the water infrastructure too. The areas of vulnerability for managed water supplies, as distinct from natural vulnerability, are surprising and include large parts of Eastern Europe and North America, as well as Asia.

The BBC report is based on an article in Nature that's worth reading.The article goes further than the report in making the link between underinvestment in water infrastructure and threats to freshwater biodiversity.

Prevailing patterns of threat to human water security and biodiversity.
Source: doi:10.1038/nature09440

As the figure above shows, the regions with the most threatened human water supplies and biodiversity loss are in Asia and Africa, a region that faces numerous water and biodiversity challenges.

The Article

Vorosmarty, C. J., McIntyre, P. B., Gessner, M. O., Dudgeon, D., Prusevich, A., Green, P., et al. (2010). Global threats to human water security and river biodiversity. Nature, 467(7315), 555-561. doi:10.1038/nature09440

Researchers' Pages

Charles Vorosmarty

Peter McIntyre

Mark Gessner

David Dudgeon

Alex Prusevich

Pamela Green