5 October 2012

Japanese Health Impact Assessment Practice

Guest post by Michiko Hoshiko

Health Impact Assessment (HIA) is not yet a routine part of public decision-making in Japan, though there are an increasing number of examples of HIA’s use.
Before any regulatory assessment measure can be adopted in Japan it’s necessary to demonstrate its economy, efficiency and effectiveness, so this forms the focus of much current HIA activity. In 2011 the Japanese Public Health Association produced guidance on HIA 1), focusing on how to do it.

The Kurume University School of Medicine and the University of Occupational Environmental Health have been centres for the development of HIA in Japan to date. The case studies below describe some of the HIAs and research that has been conducted.

Kurume University School of Medicine

1) Health impact assessment of the transition to a core city in Japan2)
The city of Kurume became a core city in 2008, which is a more autonomous level of regional government that some cities in Japan are eligible for. A core city requires a population at least 300,000 people and allows the transfer of administrative authority from prefecture to more independent municipal government. A rapid HIA was conducted on the transition to a core city because potential health impacts were identified for public servants in Kurume as well as residents.

2) Assessing the validity of health impact assessment predictions regarding a Japanese city’s transition to core city status: A monitoring review3)
The validity of health impact assessment predictions has not been accurately assessed comparing predictions with subsequent data. An HIA into the transition of Kurume to a core city was conducted before the transition, but the recommendations were not accepted and adopted by city officials. A monitoring review was performed one year after the transition to guage the accuracy of the HIA predictions by evaluating the correlation between the predicted impacts and what ended up happening.

3) Prioritization of health impact assessment on the management transformation of a municipal hospital in Japan
Municipal hospitals in Japan are currently facing a serious eonomic management crisis because of operating deficits and doctor shortages. Unprofitable departments, including obstetrics and paediatrics, have been closed at some hospitals, which has caused controversy in a number of local communities. The aim of our study was to examine the health-related impacts of management and service changes at a municipal hospital close to the Kurume University School of Medicine on residents, patients, and hospital staff.

4) Development of a Health Impact Assessment Screening Tool for Use at the Municipal Level4)
The aim of this study was to make an HIA screening tool for use at the municipal level in Japan. The HIA screening checklist is versatile and applicable across a range of projects. The intended users are municipal officers and as such we wanted it to be short and usable.

University of Occupational Environmental Health)

5) Development of HIA screening tools for policies and projects5)6)
In screening you try to identify as many potential health impacts as possible. This should include not only scientific knowledge but also “lay knowledge” that incorporates information such as the anxieties and fears of stakeholders. This screening tool allows stakeholders to participate in the identification of potential health impacts and to characterize them in terms of being positive and negative, as well as their potential severity. This is then used in the decision to proceed with the HIA or not.

6) HIA of closing a research laboratory7)
Due to changes in the economic climate a major laboratory for an international corporation was closed. An HIA was conducted to look at the potential impacts on workers, who are both domestic and come from overseas.

7) HIA for introducing for reemployment system after retirement8)
Japan is facing a rapidly ageing population, with reduced birth rates and the retirement of the post-war Baby Boomers. A number of companies have reintroduced “re-employment” shemes for workers who have already retired to address workforce shortages. This HIA looked at the potential positive and negative health impacts of re-employment schemes.

References

1)      Public health monitoring report commission: Health Impact Assessment Guidance. Jpn J Public Health, 58:989-992, 2011 (in Japanese)   
2)      Hoshiko M Hara K, Ishitake T: Health Impact assessment of transition to a core city in Japan. Public Health, 123:771-781, 2009  
3)      Hoshiko M Hara K, Ishitake T: Assessing the validity of health impact assessment predictions regarding a Japanese city’s transition to core city statue: A monitoring review. Public Health, 126:168-176,2012
4)      Ishitake T: Development of a Health Impact Assessment Screening Tool for Use at the Municipal Level. HIA 2012 international conference in Quebec.
5)      Fujino Y, Nagata T, Kubo T, Uehara M, Kajiki S, Oyama I, Dohi K,
Mori K: Application of HIA for enterprise [1], Science for Labour 67(1)
32-35, 2012 (in Japanese)
6)      Nagata T, Fujino Y, Kubo T, Uehara M, Kajiki S, Oyama I, Dohi S, 
Mori K: Application of HIA for enterprise [2], Science for Labour 67(2)
40~43, 2012 (in Japanese)
7)      Nagata T, Fujino Y, Kubo T, Uehara M, Kajiki S, Oyama I, Dohi S, 
Mori K: Application of HIA for enterprise [6], Science for Labour 67(6)
26~29, 2012
8)      Tanaka H, Uehara M, Fujino Y, Nagata T, Kubo T, Kajiki S, Oyama I,
Dohi S, Mori K: Application of HIA for enterprise [7], Science for Labour
67(7), 38~42, 2012