31 March 2011

Preserve welfare spending to protect population health, not health budgets

There's a fascinating argument in the recent BMJ that efforts should be devoted to ring-fencing
Governments may feel they are protecting health by safeguarding healthcare budgets, yet David Stuckler, Sanjay Basu, and Martin McKee argue that social welfare spending is as important, if not more so, for population health.
David wrote a piece for the International Association for Impact Assessment's Health Quarterly in 2009 on the health impacts of the global financial crisis that's worth reading too.

Hat-tip to Malcolm Lewis for the article.

30 March 2011

Health and the Environment: A compilation of evidence

The Australian Institute of Health and Welfare has released a useful summary of the links between health and the environment:

Why look at environment and health?

There is increasing awareness that our health and the environment in which we live are closely linked, and in 2006 the World Health Organization (WHO) estimated that 24% of the global burden of disease was due to modifiable environmental factors. This growing awareness is reflected in recent health and environmental initiatives from governments and other organisations.

How does this report help?

Given the abundance and diversity of literature, it is useful to summarise and increase access to information regarding health and the environment. As new evidence is constantly emerging, this report does not seek to provide definitive conclusions about this relationship. Rather, it draws upon key studies and synthesises the main findings related to a selected list of 15 environmental factors. The report also notes that it can be difficult to assess the relationship between health status and environmental factors for a number of reasons.

What are the main findings?

Overall, the report indicates that the environment can be a major determinant of our health and how we live. In general, the results reported here demonstrate that:

  • Our surroundings can influence our health through a variety of channels—through exposure to physical, chemical and biological risk factors or by triggering changes to our own behaviour or the behaviour of those around us. Such effects may be direct (such as injury or death) or indirect (through changes in lifestyle and health behaviours).
  • The environment has the potential to affect physical health (for example, respiratory problems due to air pollution) and mental wellbeing (for example, poor mental health associated with drought conditions). Conversely, there are natural and modified features of the environment (such as green space and water fluoridation) which benefit health.
  • There is a growing awareness that humans, through their intervention in the environment, play a vital role in exacerbating or reducing health risks.

Examples of the report’s detailed findings include:

  • From official records, bushfires killed 815 people in Australia between January 1851 and December 2010 (see Section 3.3).
  • A large study found that people living in more walkable neighbourhoods (characterised by connected streets, high residential density and pedestrian-oriented shopping) were less likely to be obese than people living in less walkable areas (see Section 4.3).
  • A study using data from the National Health Survey showed that overcrowding was responsible for 30% of the health gap between Indigenous adults living in remote areas and the non-Indigenous population (see Section 4.7).

What don’t we know?

There is a lack of data on exposure to environmental hazards and health outcomes, particularly at a local level. As such, the health effects of many aspects of the environment have not been systematically evaluated, and there is associated uncertainty about causality because the pathways involved may be indirect and complex. Despite these limitations, this report provides insight into the relationship between the environment and health

The data is quite focused on the Australian context but it's still well worth a look. You can download the report here.

29 March 2011

Forthcoming Book on Health Impact Assessment: Principles and Practice

Our friend Martin Birley has a book on HIA coming out:
"The purpose of this book is to fill this gap and to introduce the subject of Health Impact Assessment using plain language, in both general and specific contexts and with reference both to market and less developed economies. As a result, the reader should be able to describe what HIA can and cannot achieve, identify the components of a successful HIA and participate in an assessment as a member of a team. Examples are provided from a number of planning and development sectors, including extractive industry, water resource management, and housing. The reader, whether student or professional, need not be a health specialist, although prior knowledge of some public or environmental health would be an advantage."

“To many people, Health Impact Assessment is a new concept requiring new skills. A pioneer and global expert in the subject, Dr Birley has been grappling successfully with this challenge for many decades. His book reveals extraordinary experience and insight, providing depth and context to existing HIA guidelines, invaluable to those who are trying to use them."
Sir Michael Marmot,
Professor of Epidemiology & Public Health, Chair of the Commission on Social Determinants of Health and current president of the BMA

“I warmly commend this book. Apart from being by far the most useful work on how to operationalize Health Impact Assessment, the book is brilliantly comprehensive and a profoundly wise distillation of the author’s unparalleled experience worldwide.”
Dr Robert Goodland,
former Senior Environmental Advisor at the World Bank and former president of the International Association for Impact Assessment
It looks like it will be a great read and useful to everyone with an interest in HIA. You can find out a lot more about the book here.

It's also being launched at the HIA Conference in Granada so please make sure to drop by if you're attending.

Updated: The IAIA Health Key Citations Series

Key Citations Series - Health. Fargo ND: International Association for Impact Assessment, 2011.

21 March 2011

Psychosocial impact of floods

There's an interesting article in BMC Public Health (open access) about the psychosocial impact of the 2007 England floods. It seemed quite timely given the recent major flooding in Bazil and Australia.

The summer of 2007 was the wettest in the UK since records began in 1914 and resulted in severe flooding in several regions. We carried out a health impact assessment using population based surveys to assess the prevalence of and risk factors for the psycho-social consequences of this flooding in the United Kingdom.

Surveys were conducted in two regions using postal, online, telephone questionnaires and face-to-face interviews. Exposure variables included the presence of flood water in the home, evacuation and disruption to essential services (incident management variables), perceived impact of the floods on finances, house values and perceived health concerns. Validated tools were used to assess psycho-social outcome (mental health symptoms): psychological distress (GHQ-12), anxiety (GAD-7), depression (PHQ-9) and probable post-traumatic stress disorder (PTSD checklist-shortform). Multivariable logistic regression was used to describe the association between water level in the home, psychological exposure variables and incident management variables, and each mental health symptom, adjusted for age, sex, presence of an existing medical condition, employment status, area and data collection method.

The prevalence of all mental health symptoms was two to five-fold higher among individuals affected by flood water in the home. People who perceived negative impact on finances were more likely to report psychological distress (OR 2.5, 1.8-3.4), probable anxiety (OR 1.8, 1.3-2.7) probable depression (OR 2.0, 1.3-2.9) and probable PTSD (OR 3.2, 2.0-5.2). Disruption to essential services increased adverse psychological outcomes by two to three-fold. Evacuation was associated with some increase in psychological distress but not significantly for the other three measures.

The psychosocial and mental health impact of flooding is a growing public health concern and improved strategies for minimising disruption to essential services and financial worries need to be built in to emergency preparedness and response systems. Public Health Agencies should address the underlying predictors of adverse psychosocial and mental health when providing information and advice to people who are or are likely to be affected by flooding.

17 March 2011

Climate Shocks: Turning Crisis into Opportunity

An interesting, if somewhat pessimistic lecture by Thomas Homer-Dixon on the impending (if not current) climate shocks and the opportunities they may afford us. Abstract:
"Climate policy is gridlocked nationally and globally, with virtually no chance of a breakthrough under current conditions. Policy makers need to accept that societies will not make drastic changes to address climate change until a climate crisis hits. The recent financial crisis showed that when powerful special interests have convinced much of the public that what they are doing is not dangerous, only a disaster that discredits those interests will provide an opportunity for comprehensive policy change. Societies that have response plans on the shelf will be far better off than those that are blindsided. The task for national and regional leaders, then, is to develop a set of contingency plans for possible climate shocks — what we might call, collectively, Plan Z. Such a plan should include detailed scenarios of plausible climate shocks; close analyses of options for emergency response by governments, corporations and nongovernmental groups; and clear specifics about what resources — financial, technological and organizational — we will need to cope with different types of crises."
Presentation and audio and video downloads

16 March 2011

New Austrian Website on Health Impact Assessment

CNBC Financial Report on "Externalities"...

CNBC's Larry Kudlow on the earthquake in Japan:
"The human toll here looks to be much worse than the economic toll and we can be grateful for that."

Upcoming Webinar: What Shapes Health?

The Robert Wood Johnson Foundation is organising a webinar on "What Shapes Health?" The program will look at:
  • How do early life experiences affect health throughout life?
  • How important is health education in shaping healthy behaviours?
  • How does stress in early childhood affect the brain and other organs, with lifelong consequences for health?
  • What can policy-makers and advocates do to reduce health care costs and improve lifelong health for all Americans?
There's an impressive line-up of speakers, including David Williams, Paula Braveman, Susan Egerter and Jack Shonkoff.

2:00pm-3:30pm US Eastern Time 24 March 2011
Register here

USA: HIA Funding Opportunity with the Health Impact Project

The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, is accepting brief proposals through June 1, 2011 for grants to conduct health impact assessments (HIAs). The funding will enable awardees to develop an HIA, which is a study that can help policy makers and community members identify and address the potential, and often-overlooked, health implications of proposed policies and projects in a broad range of sectors, such as agriculture, energy, transportation and development.

The Health Impact Project will fund up to eight HIAs to identify how policy proposals will impact health at the local, tribal or state levels. Grants will range from $25,000 to $125,000 and will support government agencies, educational institutions and nonprofit organizations.

For more information and to apply online, visit www.healthimpactproject.org.

1 March 2011

USA HIA Update from Human Impact Partners

This is an excerpt of the Human Impact Partners' February update.

Project Updates

Our work to complete HIA projects has definitely picked-up over the past few months. While 2010 was the year of HIA training and technical assistance, it seems that 2011 is the year of HIP completing some exciting and innovative HIAs of our own.

For example, with a generous grant from The California Endowment, HIP has launched into an intensive assessment phase in our School Discipline Health Impact Assessment. To date, HIP has developed a scope for the HIA; is conducting a quantitative analysis of how Positive Behavioral Interventions and Supports (PBIS) as a discipline policy and practice affects suspensions, expulsions, and graduation rates; and is collecting qualitative data on violence, mental health, and social cohesion outcomes as they relate to various school discipline approaches. Using Oakland, Los Angeles and Salinas as case studies, and working with local partners such as CADRE in Los Angeles, we hope that the HIA will contribute to ongoing campaigns and efforts to address the “school to prison pipeline.”

On the built environment HIA front, HIP continues to make progress on the I-710 Corridor HIA and the Lake Merritt BART Station Area Plan HIA.

In terms of new HIA projects, HIP is excited to be working with the Robert Wood Johnson Foundation/Pew Charitable TrustsHealth Impact Project to scope an HIA on the next federal farm bill. At the local level, HIP began working with the Legal Aid Foundation of Los Angeles on a rapid HIA of the proposed Long Beach Downtown Community Plan. The HIA will have a specific focus on assessing plan impacts to affordable housing, displacement, and employment opportunities.

HIP’s technical assistance work continues as well, and we have several exciting new partnerships to support. The City of Philadelphia’s “Get Healthy Philly” program (funded through the American Recovery and Reinvestment Act) has asked HIP to support the Health and Planning Departments as they conduct HIAs on local district (i.e., area/community) plans. The California Department of Public Health has also asked HIP to mentor three county public health departments in California as they complete rapid HIAs on grocery retail models (Alameda), a redevelopment plan (Fresno), and a regional transportation plan (San Mateo). Last, we are providing TA to the Planning Department in Northampton, Massachusetts as they conduct an HIA on policies to improve access to healthy food.

Institutionalizing Health Impact Assessment

Through all of our work, we are encouraged by the openness of government agencies at local, state and federal levels to HIA concepts. Increasingly, agencies want to incorporate health earlier in their decision-making processes and are looking to HIA to provide a model for accomplishing their public health program goals. Given this interest, HIP recently completed a draft HIA plan that identifies core strategies and activities to institutionalize HIA within various levels of government. The primary strategies promoted in the plan include:
  1. advancing an educational campaign to build support for prescriptive requirements for HIA,
  2. integration of HIA in environmental impact assessment practices, and
  3. working with governmental institutions to voluntarily implement HIA practices (for example, through Health in All Policies approaches).
Through an intensive outreach effort to public health, planning and equity partners across the community-based, advocacy and government spectrum, HIP received feedback on the core strategies in the institutionalization plan and prioritized a set of activities to guide this work over the next one to two years. If you are interested in getting involved in these efforts, please let us know – we would be happy to work with those who are willing! We recognize that the path to institutionalizing HIA, and getting health incorporated in decision-making more broadly, requires partnerships at all levels and we welcome the opportunity to work with individuals and organizations that are committed to advancing this work.

Society of Practitioners of Health Impact Assessment (SOPHIA)

As part of HIP’s continuing work with HIA practitioners in North America, we are excited to announce the start of a new HIA practitioners group which grew out of the March 2010 HIA of the Americas meeting co-hosted by HIP. The Society of Practitioners of Health Impact Assessment (SOPHIA) will be an association of individuals and organizations providing leadership and promoting excellence in the practice of health impact assessment. The increasing number of HIA practitioners and demand for more formal networking structures and standards for practice drove the development of a formal association. Currently, a provisional steering committee has been formed (with Jonathan as Chair) and subcommittees have begun meeting to develop bylaws, engage potential members (including those outside North America), begin shaping SOPHIA’s activities for members, and plan the next HIA of the America’s conference (October 3 & 4 in Oakland). If you are interested in getting involved in SOPHIA, please contact any one of us and we will be happy to include you as the association is launched.


In 2010, HIP staff presented at over 15 conferences across the country. We think this is a result of the growing excitement in the U.S. about HIA. One highlight was the American Public Health Association (APHA) annual meeting in Denver, where, in addition to participating in other sessions, HIP organized and moderated a panel on HIA. The session was moderated by Lili and included a diverse set of perspectives, including Angelo Logan from East Yard Communities for Environmental Justice, Aaron Wernham from the Health Impact Project, and Marnie from HIP. The session was a big success and as a result we’ve been invited to submit a session proposal for the 2011 APHA annual meeting.

Similarly, at the New Partners for Smart Growth Conference this past month, HIP presented at two well attended sessions on HIA: one focused on the use of health based information and health impact assessment to shape local planning processes in San Mateo County; and the other, a half-day session, introduced HIA and examples of its application from around the country.

Resources and Announcements

We wanted to share some exciting new HIA resources and announcements that may be useful to you:
-Casey, Celia, Holly, Jen, Jonathan, Kim, Lili, Marnie, Rachana