31 January 2011

Using Labour Force Survey data to measure between country health inequalities

Interesting report where the author's have used Eurostat’s Labour Force Survey (LFS) data to measure health and socioeconomic inequalities in health in 25 European countries between 1983–2004.

There are limitations to using LFS data to measure health and inequalities however the it is still likely to have value in measuring socioeconomic inequalities.

The authors found health inequalities to have been increasing for most countries and health indicators.

Click below to download the report.

What does Eurostat's Labour Force Survey say about health and health inequalities in the European Union 

30 January 2011

Open Access Article: Rapid Equity Focused HIA of a Policy Implementation Plan

A paper I wrote with colleagues at CHETRE was published and for once it's open access, i.e. free, rather than being stuck behind an academic publisher paywall:

Harris-Roxas B, Harris P, Harris E, Kemp L. A rapid equity focused health impact assessment of a policy implementation plan: An Australian case study and impact evaluation, International Journal of Equity in Health, 10:6. doi:10.1186/1475-9276-10-6

29 January 2011

Developing a Population Approach to Gambling: the health issues

The Institute of Public in Ireland has recently published a short paper on the public health issues surrounding gambling in Ireland that has wider international relevance.

Key findings that I'd like to share are:

  • Participation in gambling can be seen as a continuum from those who do not participate at all to those who are addicted.
  • Gambling can negatively affect significant areas of a person’s life, including mental and physical health, employment, finances and relationships with others.
  • Only a small proportion of those who gamble run into difficulty but for those who do there is a ripple effect with implications for family and community health and wellbeing.
  • Adopting a population based screening tool for gambling can help to understand and determine the extent of gambling in society.
  • A population approach is required to understand the prevalence of problem gambling, minimise harm including potential social costs and protect vulnerable groups.
  • Adolescent gambling is thought to be 2-3 times the rate of adults.
  • From an economic perspective, evidence suggests that the health and social costs of problem gambling exceed government revenue gained from gambling taxes and businesses.

26 January 2011

The Truth Can Wear Off in Science

Very interesting article by Jonah Lehrer in the New Yorker title The Truth Wears Off about how scientific findings can see robust positive findings at first but these findings 'decline' with repeated experimentation by others. The author discusses a number of reasons from random error/chance finding in the earlier studies leading to regression to the mean in subsequent studies, human bias (selective reporting i.e. subtle omissions and unconscious misperceptions) and publication bias (positive findings are more likely to be published).

Read the full article at the New Yorker by clicking here.

21 January 2011

Save the HIA Gateway Campaign - we need your support - 8th UPDATED SUPPORTER LIST- 2nd May 2011

The HIA Gateway which has been funded by the English/UK Department of Health for the last 7-8 years and for those that don't know it can be found at www.hiagateway.org.uk is under threat. Its likely that the pages will remain but there will be no one to update them and as we all know resources that aren't updated increasingly lose their relevance except as a historical archive. Worse, they then tend to disappear as visitors numbers to the web pages declines.

We nearly lost it a few years back when the Health Development Agency was merged into the national Institute of Clinical Excellence.

Support the Campaign by sending an email with your name, organisation and the value of the HIA gateway to savehiagateway (a) gmail.com. You can also add your support in the comments. You can also do both!

We will be sending the following letter with the names of supporters to key people in the UK Government, Department if Health and key professional health associations.


Click here to check out the reasons why people want the HIA Gateway to be saved.



Rt Hon Andrew Lansley CBE MP (Secretary of State for Health)
Anne Milton MP (Parliamentary Under Secretary for Public Health)
Rt Hon Eric Pickles MP (Secretary of State for Communities and Local Government)
Ed Milliband MP (Leader of the Opposition)
John Healey MP (Shadow Secretary of State for Health)
Diane Abbott MP (Shadow Public Health Minister)
Debbie Abrahams MP (MP for Oldham East and Saddleworth)

Una O’Brien (Permanent Secretary, Department of Health)
Dame Sally Davies (Chief Medical Officer, interim, Department of Health)
Tim Baxter (Head of Public Health Development, Department of Health)
Sunjai Gupta OBE (Deputy Director, Head of Public Health Strategy and Social Marketing, Department of Health, currently overseeing the HIA Gateway)
Mike Kelly (Public Health Excellence Centre Director, National Institute of Clinical Excellence)

Rosemary Marr (Director for Health Improvement, Department of Health)
David Harper (Deputy Chief Medical Officer, Department of Health)
Anita Marsland (Executive Officer, PH England)
Brian Ferguson (Chair, Association of Public Health Observatories)
Alison Patey (Network Director, Association of Public Health Observatories)

David Prout (Director General Localism Group, Department for Communities and Local Government)
Andrew Campbell (Director, Strategy and Programme Team, Department for Communities and Local Government)
Dr Clare Gerada (Chair of The Royal College of General Practitioners)
Professor Lindsey Davies CBE (President of The Faculty of Public Health)
Richard Parish (Chief Executive, Royal Society for Public Health)
Paul Lincoln OBE (Chief Executive of the National Heart Forum)
Modi Mwatsama (International Programme Manager, National Heart Forum)

LETTER SENT : 3rd Feb'2011

Dear Sir/Madam,



The UK is an internationally-recognised leader in the theory and practice of health impact assessment (HIA).

HIA is seen by many institutions internationally as an important approach to ensuring Healthy Public Policy and Healthy Development including the World Bank and International Monetary Fund (which last year published a guide on HIA) as well as the World Health Organization (which has a web portal on HIA).

HIA is now practiced across the globe from North America (Canada and very strongly in recent years in the USA), South America (Brazil), across Europe (the devolved nations, Ireland, Spain, Germany, Sweden, Switzerland, etc.), Africa ( in particular as part of development bank lending conditions), South East Asia (Thailand, Laos, Vietnam, Mongolia and Japan) as well as Australia and New Zealand.

In England, as part of regulatory assessment, it is one of the mandatory Specific Impact Tests for all new policies, plans and programmes across Government. At local level it is widely seen as good practice and many local authorities and primary care trusts/ health boards have embedded HIA into their local policy and development planning processes. It is also an important component of Strategic Environmental Assessment and Sustainability Appraisal.

As with all forms of IA, HIA is fundamentally about spending a small amount of money now to avoid major expenditure at a later date on rectifying problems that could have been foreseen and hence very much needed in these economically difficult times.

We, the undersigned, are writing to make a case for the continued funding of the HIA Gateway as a cost-effective use of public money to protect and improve local community health and wellbeing. The funding will help maintain a national and international public health resource through keeping an up-to-date set of electronic HIA resources, contact lists and news and to have a national and international point of contact for questions about English/UK HIA.

The cost of maintaining this resource is dwarfed by the added value that this resource has delivered and will continue to deliver in the future in England and the UK not to mention the international kudos that this resource provides to the Department of Health.

We therefore urge the Department of Health and the Government to ensure that the funding for the HIA Gateway is maintained and protected over the life of this and future parliaments.

We would also welcome the opportunity to have a meeting to discuss the value and future of the HIA Gateway.

Yours sincerely,


UK (50)
Salim Vohra (Institute of Occupational Medicine)
Andy Pennington (University of Liverpool)
Ben Cave (Ben Cave Associates)
Jenny Mindell (University College London)
Mary Mahoney (University of Gloucestershire)
Debbie Fox (University of Liverpool)
Alex Scott-Samuel (University of Liverpool)
Anthea Cooke (Inukshuk Consultancy)
Eva Elliott (Cardiff Institute of Society and Health)
John Kemm, (JK Public Health)
Sue Wright (West Midlands Public Health Observatory)
Marcus Chilaka (University of Salford)
Gifty Amo-Danso (Institute of Occupational Medicine)
Ifeoma Dan-Ogosi (Institute of Occupational Medicine)
Martin Birley (Birley HIA)
Andrew Buroni (RPS)
Liz Green (Wales Health Impact Assessment Support Unit)
Margaret Douglas (NHS Lothian)
Judy Kurth (Stoke-on-Trent City Council)
Stacy Sharman (Stoke-on-Trent City Council)
Collette Taylor (NHS North Lancashire)
Jenny Dunwoody (Arup)
Clare Kingscott (Conwy County Borough Council)
Russell Jones (Glasgow Centre for Population Health)
Martin McKee (London School of Hygiene and Tropical Medicine)
Alex Trouton (NHS Southwark)
Jilla Burgess-Allen (NHS Stockport)
Steven Prosser (NHS South West Essex Community Services)
Jude Stansfield (Government Office North West)
Deborah Harkins (Lancashire Public Health Network)
Heather Catt (Lancashire County Council)
Graham Esson (Perth & Kinross Council)
Dr Ellie Hothersall (University of Birmingham and NHS Stoke)
Kayt Horsley (Lancashire County Council)
Mark Broomfield (AEA Technology)
Alison Farrar (ChaMPS public health network)
Paul Johnson (Arup)
Paul Tomlinson (URS/Scott Wilson)
Nicola Morrow (Sunderland City Council)
Janet Willams (Assoc. of Voluntary Organisations in Wrexham)
Bruce Poole (Tameside Metropolitan Borough Council/NHS Tameside and Glossop)
Lucy Smith (NHS Lambeth)
Matthew Ashton (NHS Knowsley / Knowsley MBC)
Paul Fisher (Solihull NHS Care Trust)
Stephen Watkins (Stockport PCT)
Aamer Raza (Independent HIA and EIA Consultant)

Sandra Husbands (NHS Harrow)
Chimeme Egbutah (Luton Borough Council/NHS Luton)
Jacqui Thompson (NHS North Lancashire)
Emer O'Connell (Public Health Trainee, London)

International (20)
Ben Harris-Roxas (University of New South Wales, Australia)
Samantha McCrea (ERM, Australia)
Rob Quigley (Quigley and Watts, New Zealand)
Carlos Artundo (Andalusian School of Public Health, Spain)
Patrick Harris (University of New South Wales, Australia)
Meri Koivusalo (National Institute for Health and Welfare, Finland)
Marla Orenstein (Habitat Health Impact Consulting, Canada)
Murray Lee (Habitat Health Impact Consulting, Canada)
Jane Branscomb (Georgia State University, USA)
Jonathan Heller (Human Impact Partners, USA)
Jessica Anson (Monash University, Australia)   
Francesca Viliani (International SOS)
Richard Morgan (University of Otago)
Antonio Daponte (Andalusian School of Public Health, Spain)
Alberto Fernandez Ajuria (Andalusian School of Public Health, Spain)
Cathleen Baker, (San Mateo County Health System, USA)
Ame-Lia Tamburrini (Habitat Health Impact Consulting, Canada)         
Mette Winge Fredsgaard (MWF Consult, Denmark)

Mark Divall (SHAPE Consulting, South Africa)
Lee Roberts Thompson (USA)

20 January 2011

Organised crime and the efforts to combat it: a concern for public health

A very interesting open access article in the journal Globalization and Health at:


Read the whole article but to whet your appetite here is their conclusion about the value of a public health perspective in this area:

First, it recognises the importance of looking
upstream, avoiding what has long been termed “victim
blaming” in which existing law enforcement measures
often criminalise the victims, such as those who have
been trafficked, or vulnerable people who have developed
addictions. They are often much easier to identify
than those who control the business, and are unable to
evade the consequences through bribery or intimidation.

Second, it emphasises the importance of evidence of
effectiveness. Unfortunately, there is still limited
research to draw on; the Campbell Collaboration http://
www.campbellcollaboration.org does now contain systematic
reviews of interventions to tackle crime, but so
far most address primarily micro-level issues. Rigorous
and comprehensive evaluation is especially important in
this area given the evidence reviewed above showing the
scope for unintended consequences.

Third, it has long recognised the importance of context.
Organised crime is more common in countries
when the rule of law is weak. An absence of high-level
political interference, strong private sector governance
and regulation, an effective judicial system, and an independent
and honest judiciary all deter corrupt behaviour
and weaken criminal networks [114]. Research on illicit
drug use in both recipient and supplier countries
identifies how “the capacity of the state to maintain a
viable and legitimate presence in local communities
determined the extent to which drug-related activities
developed and consolidated at local level” [14]. Consequently,
it is necessary to take account of the quality of
governance in implementing any measures.

Fourth, a public health approach stresses the importance
of inter-sectoral collaboration. Addressing the
major threats to health today requires inputs from many
sides. Organised crime is no exception. Yet, too often
the relevant experts exist within silos, rarely seeing the
need to engage with each other. The public health community
can play a convening role, helping to break
down these barriers.

To conclude, the tentacles of organised crime have
huge reach, as demonstrated above, and may adversely
impact the health of many millions of people around
the globe. Through fear induced by brutality and corruption,
the perpetrators enjoy not only a high level of
impunity but also extraordinary invisibility. We hope
that, by bringing together a wide range of evidence from
disparate areas of research, we have begun to make the
case for a joined-up, evidence-based approach to addressing
the global health consequences of organised crime.

17 January 2011

HIA, ethics, private sector consulting and clients

This is a post I put up on the HIA community wiki website over two years ago. It still has relevance and I have been debating about putting it up on the HIA blog as a much better place for discussion. In the UK there was/is concern and potentially continuing concern among some HIA practitioners about the growing role of large private sector environmental consultancies moving into the HIA field.

The main thrust of the concern is that private sector consultancies do not necessarily have the public health skills and/or public health ethos to do good HIAs and may therefore further their clients interests at the expense of affected communities, in particular, and other stakeholders in general.

This concern can and should be leveled at all practitioners and is something that all practitioners must think about on an ongoing basis whether they are private, public or not-for-profit sector HIA consultants and researchers. There are personal agendas, organisational agendas and politics that impinge on HIA practitioners working in all sectors and professions.

The specific concern about private sector consultancies was I thought then based on a mistaken premise that consultancies do not work by any set of organisational or professional ethics. Unless the argument is that public health has a very special set of ethics which environmental, engineering and planning professionals do not have, cannot share and are unable to foster in themselves and their profession?

Given that private sector consultancies are and will increasingly move into public health consultancy the more urgent question I feel is how to ensure that public health values fit alongside environmental, engineering and other professional values and ethos' such that they complement and do not work in tension with each other.

Not proactively engaging with them will simply create two (or more)  parallel and potentially opposing strands of thinking and doing HIA. More significantly it disrespects the environmental and planning professionals as professional communities who have and continue to grapple with ethical dillemmas that are faced in their areas of work.

Personally, I constantly grapple with ethical dilemmas - both in my personal and professional life - and even over the last year I have had quite a few. These ethical dilemmas have ranged from whether or not to formally critique a fellow HIA practitioners work to whether or not to consider writing a proposal for a HIA of a proposed development because the nature of the development raised conflicts with certain values I held.

For me, ethical dilemmas don't go away because I have a set of implicit/explicit ethical principles; they just bring into sharp relief issues that I need to consider carefully before proceeding. Ultimately, I and we are still the ones who have to make the decision, ethical principles are guides but they can't make decisions for us. Neither are there one set of ethical principles that can work in all contexts; sometimes different ethical principles are at odds with each other and this conflict can only be resolved by making a personal choice to go one way or another. In these situations it is the process of thinking through and making a choice after due reflection and consideration that is the critical step.

So how do we go about fostering a public health ethos in the private sector?

First, by recognising that they already have an ethos that they work by that has been developed from the profession that they are in and upheld by their professional institutes and associations. Just as HIA and public health ethics is developed in public health education and training and upheld by public health colleges, institutes and associations (even if we don't have HIA institutions).

Second, by developing links between these institutions to foster collaborative working and the development of a set of widely held and agreed upon professional ethical principles of HIA practice. For example the Health Good Practice Principles of the International Association for Impact Assessment.

Third, by more collaborative working, thinking and reflection across the not-for-profit, public and private sector HIA practitioners about these kinds of issues.

Do my arguments make sense, have I missed anything crucial or have I got it completely wrong?

14 January 2011

2012 International HIA Conference – Hosts Wanted - 28th Feb' 2011 Deadline

The next International  HIA Conference will be held 14-15 April 2011, in Granada, Spain. Meanwhile we are working urgently to find a host and fix a venue and date for the next conference in 2012.

A small working group has taken on the task of searching for and selecting a host for the next International HIA conference. This working group is chaired by the  host of the current conference, Carlos Artundo, and consists of those who have hosted the previous four International HIA Conferences (Eva Elliott, Owen Metcalfe, Alex Scott Samuel, and, Lea den Broeder).

The International HIA Conference Working Group invites proposals for hosting of the 2012 International HIA Conference.

Future hosts are asked to:
  • Provide evidence that ensures  the support of their organisations ;
  • Describe their ability for underwriting the conference;
  • Describe the proposed location and date of the conference
  • Outline the possible themes of the conference
The proposer selected to host the conference will be asked to
  • Make a short presentation on  the location date  and theme of the 2012 International HIA conference at the upcoming conference  in Granada (April 2011);
  • Be prepared after hosting the conference to pass on their conference organiser’s report, experiences, registration data, web site, and (if any) rollover budget to the next host;
  • Chair the working group looking for the 2013 host.
The working group will be happy to share with anyone considering hosting future conferences the experience built up from previous conferences of what hosting the conference entails, the facilities that have to be provided and the costs.

Future hosts are asked to send their proposal to Carlos Artundo, e-mail c.artundo (at) telefonica.net

The deadline for submitting proposals is 28 February 2011. We will then select the host from among those who have submitted proposals before 15 March 2011 and notify proposers of the outcome. This will allow  a definite venue and date for the next conference to be announced at the  International HIA Conference in Granada in April 2011. 

11 January 2011

The Impacts of Health System Reforms: The triumph of hope over experience?

Many health systems around the western world are being restructured, with major implications for preventive health agendas. This also means big changes to the contexts in which health impact assessments are undertaken and supported (or not).

The NHS Confederation in the UK has produced a fascinating report that looks at the available evidence about health system reorganisations and their impacts:
Although there is widespread acknowledgement of the problems of frequent reorganisation, there is still a tendency for it to be enthusiastically advocated as a solution - often with little reference to the problem it is trying to solve...

Even if there had been a more systematic evaluation, the number of changes in the last two decades means that many structures have had little time to settle down and produce results before being reorganised...

Poorly designed organisations and hasty change are likely to result in further restructuring.

Source: Edward N. (2011) The Triumph of Hope Over Experience, NHS Confederation: London.
In Australia, 1 January 2011 heralded the next round in the seemingly endless series of reforms and restructures. There's a lot we can learn from the report.

6 January 2011

Public Health Works Seminar Series Presentations

I came across a very interesting website - Public Health Works - while (as usual) searching for something else. I'm not sure if the seminar series presentations are still active but the recent and old ones are worth a look.

The presentations can be found at http://www.publichealthworks.ca/archive.htm

The ones I found interesting were:

3 January 2011

Hidden Cities: unmasking and overcoming health inequities in urban settings

The rapid increase of people living in cities is one of the most important global health issues of the 21st century. In this joint WHO/UN-HABITAT report, the latest information on urbanization trends and the pressing need to address health inequities in cities is presented. The report is aimed at unmasking and overcoming these health inequities in urban settings and includes practical examples and recommendations on specific evidence-based interventions.

Photo stories from around the world reflect the hidden realities urban dwellers are facing, further highlighting the need for concerted action.

Through a novel analytical approach, the report outlines the crucial finding that urban averages often mask hidden pockets of ill-health and overlooked populations. Hidden Cities: unmasking and overcoming health inequities in urban settings enables city leaders and urban planners to identify the most deprived populations and target measures to improve their health.

DON'T FORGET to take the urban quiz (Gifty and I didn't do too badly, 70 and 80%, let us know you're scores).

Quote we like:
“Prevention is the heart of public health and equity its soul”M. R. Sukumbhand Paribatra, Governor of Bangkok

Download the report at http://www.hiddencities.org