3 December 2013

Global Health 2035

A really interesting and thoughtful piece by Dr Charles Clift at the Chatham House Centre on Global Health Security on the new Lancet commissioned report Global 2035: A World Converging Within A Generation (you will need to register to gain access to the full report).

He provides nice summary of the issues in the report and its historical context as a successor to the World Bank's 1993 Report Investing in Health.
My three take aways:
The report’s key innovation (akin to the DALY) is to support and popularize the concept of ‘full income’ – adding to conventional national income measures a valuation of the increase in life expectancy. On that basis it estimates that, between 2000 and 2011, 24 per cent of the growth in ‘full income’ in low and middle income countries was due to health improvements, equivalent to a 1.8 per cent per annum addition to GDP growth. Based on this methodology it concludes that ‘there is a very large payoff from investing in health’.
Its other big idea, captured in the title, is that with rising incomes in the developing world and continued improvements in health and delivery technologies, an achievable goal for nearly all countries in 2035 is to bring down infection, maternal and child mortality rates to the current levels of the four best performing middle income countries (Chile, China, Costa Rica and Cuba).
The Lancet also provides commentaries on the report by three global health leaders – Richard Horton (Lancet editor), Margaret Chan (WHO) and Mark Dybul (Global Fund) and heads of two key development institutions (Jim Kim of the World Bank and Helen Clark of the UN Development Programme). While the first group is largely favourably disposed, the latter two both focus on the commission’s failure to address the social and economic determinants of health. The report essentially argued that there are ‘complex and entrenched political obstacles’ to addressing them so it is better to focus on the health sector where a more immediate impact can be realized.
Kim and Clark argue strongly against this – they contend that there needs to be a balance between investments inside and outside the health sector if the goal of improving health is to be achieved. The global health community will need to heed these words if it wishes to find a proper place for health in the post-2015 development agenda.
I thought it ironic that the WB and UNDP (to a lesser extent) were advocating for a social determinants of health approach to the report (while the report authors were justifying why they didn't in the report)!

You can subscribe to the Global Health Security Newsletter produced by Chatham House by clicking this link.

27 November 2013

Launch: Effectiveness of Health Impact Assessment in New Zealand and Australia Report

The Centre for Health Equity Training, Research, and Evaluation invites you to attend the launch of The Effectiveness of Health Impact Assessment in New Zealand and Australia: 2005-2009 Report

Friday, 13 December, 2013
2 – 4 pm
Lavender Bay rooms 1&2,
North Sydney Harbourview Hotel
17 Blue Street, North Sydney

Webinar facilities will be available for our interstate and international attendees. RSVP to Heike Schutze: h.schutze@unsw.edu.au

21 November 2013

Reminder: Important dates for IAIA14

IA14, the 34th annual IAIA conference, will be held 8-11 April 2014 in Viña del Mar, Chile.  For more information, visithttp://iaia.org/conferences/iaia14/.

Important Dates:
6 December:  Paper/Poster Abstract Submissions Due
6 December:  Student Fee Waiver Applications Due

Paper/Poster Abstracts Invited:  The online submission form for IAIA14 paper/poster abstracts is available on the conference website under the Submissions menu. The submission deadline is 6 December 2013.

Student Fee Waivers: The Student Fee Waiver program allows up to ten students a waived conference registration fee in exchange for providing in-kind services on-site at the conference. For more information, contact Loreley Fortuny at IAIA HQ (impact@iaia.org) for program guidelines and an application form.  Completed forms are due 6 December.

Sponsorship opportunities:  IAIA is currently seeking sponsors for the IAIA14 conference.  Download the Sponsorship Opportunities brochure to find out the various ways your company can reach out to over 700 environmental professionals from 80+ nations.

8 November 2013

WHO Urban HEART Consultation Day 3

I've been invited to participate in a WHO Consultation on Urban HEART in Kobe. This is a post on Day 3 of the Consultation, there are also posts on Day 1 and Day 2.

Workshop 3: Review of Urban HEART guidance

There was a widespread view that the current Urban HEART guidance works quite well but that there are a few areas where it might be enhanced. There was discussion about the selection of interventions and responses being difficult in practice, and that it involves considerable negotiation. There wasn't agreement about the best ways to reflect this in the guidance but it was a recurrent theme, and one that's familiar in the context of HIA and negotiating recommendations.

Community participation is another aspect of Urban HEART that has been difficult to provide guidance on. Participatory rapid assessments, health assemblies, surveys, workshops, and the use of mobile and electronic engagement tools were all discussed as ways to involve communities in Urban HEART processes, though these were all recognised as having limitations.

There was quite a lot of discussion about the extent to which HIA might be integrated into Urban HEART, though it was agreed that Urban HEART and HIA are complementary rather than being processes that could be integrated. This is because Urban HEART helps to identify needs and areas for action at the city level, whereas HIA is most useful where there is a proposal or a limited set of options to assess. So whilst there are procedural similarities they serve quite different purposes and integrating them might complicate things rather than helping. The diagram below from the Urban HEART User Guide shows how WHO conceptualises Urban HEART's role in local planning cycles. Some related procedures like multi-criteria decision analysis and equity lenses were also discussed, and how they might be integrated into Urban HEART.

7 November 2013

WHO Urban HEART Consultation Day 2

I've been invited to participate in a WHO Consultation on Urban HEART in Kobe. This is a post on Day 2 of the Consultation, there are also posts on Day 1 and Day 3.

Workshop 1: Review of Urban HEART concepts

The first workshop focused on factors affecting health equity that might be missing from or not sufficiently emphasised in Urban HEART. These include things like gender, food and nutrition, emergency preparedness, conflict and security, universal health coverage and environmental sustainability.

The issue of within-neighbourhood disaggregation was discussed, particularly in terms of age and gender, but there was a broad recognition that this data simply isn't available for most indicators and that this may add a layer complexity to an already imposing process. There was also a recognition that many indicators of health equity might not be sensitive enough, or may reflect structural or systemic inequalities, to change at the local or city level. These issues will be very familiar to those who have looked at equity and vulnerability within impact assessments.

There was quite a bit of discussion about the degree to which Urban HEART needs to be regarded as a standardised, readily-comprehensible approach or something that can be adapted to local needs. This is a debate I've encountered several times in relation to HIA and the answer seems to lie somewhere between those two extremes.

City case presentations

A presentation from Dr Oyelaran-Oyeyinka from UN-HABITAT emphasised the important role cities play as the engine rooms of economic development, though the challenge is to ensure that's inclusive development. Internationally the urban-rural divide is diminishing but the rich-poor divide is increasing.

Kelly Murphy from St Michael's Hospital in Toronto presented on her work adapting Urban HEART for use in developed countries. The City of Toronto has adopted Urban HEART as a mechanism to guide funding of Neighbourhood Improvement Areas and Issue to 2020.

6 November 2013

WHO Urban HEART Consultation Day 1

I've been invited to participate in a WHO Consultation on Urban HEART in Kobe. This is a post on some of the issues discussed on Day 1, with some of my thoughts and reflections scattered throughout. There are also posts on Day 2 and Day 3.

Urban HEART grew out of the Commission on the Social Determinants of Health's work and dates back to 2007. Early activity on piloting and developing a tool were led by a few countries, notably Iran. The final report from the CSDOH gave further impetus and led to more piloting of Urban HEART in more cities. After piloting Urban HEART was extensively reviewed and Version 1 was published in 2010.

Urban HEART is conceptualised by WHO as a tool for assessment and response to health equity issues at the city level. Urban HEART was designed to meet four criteria:
  • ease of use
  • comprehensive and inclusive
  • feasible and sustainable
  • links evidence to action
It's a stepwise process with a lot of similarities to HIA. In contrast to HIA it doesn't need a proposal (even a general one or options) to assess. Rather it allows municipalities to identify issues for action and responses at the city level, and in that way it's more like a needs assessment or planning activity. It's useful where some willingness to act on health already exists, so Healthy Cities is a useful basis for action. Higher-order support is always required (which may be less true for HIA?).

Data that informs Urban HEART is almost always spread across agencies - no single one holds or reports on even the core indicators. This means multiple permissions and interagency liaison is often required, which reiterates the need for higher-order permission and negotiation at the earliest stages. Whilst this is undoubtedly desirable for HIAs as well it hasn't always been possible in my experience and HIAs often fly under the radar, at least in the early stages. I'm not sure that would be possible for Urban HEART but I'm not sure that's a bad thing. The under-the-radar HIAs I've been involved in have often encountered resistance when their recommendations are presented. A clear, unambiguous mandate and imprimatur as a basis for proceeding isn't a bad thing.

A survey of Consultation participants that was conducted in advance found that most participants thought Urban HEART works well overall, is easy to use and successfully links evidence to action, but is less successful at being comprehensive and organisationally sustainable.

Case studies from the City of Paranaque in the Philippines, Tehran in Iran and Indore in India provided a range of useful, practical lessons on the use of Urban HEART (and they were quite inspirational). The Inore case in particular modified the indicators in a way to suit the local context, in their case by ensuring that the indicators were all meaningful and comprehensible to anyone, from residents to national bureaucrats. The case studies also highlighted the need for Urban HEART to not be a one-off activity but as an activity that needs to be revisited/undertaken semi-regularly.

1 November 2013

New HIA reports from the National Collaborating Centre for Healthy Public Policy (NCCHPP). These documents are available in both English and in French on the NCCHPP's website:

Planning Knowledge Sharing in the Context of a Health Impact Assessment

http://www.ncchpp.ca/67/new-publications.ccnpps?id_article=950 (en)
http://www.ccnpps.ca/88/Nouvelles_publications.ccnpps?id_article=949 (fr)

Developing a Citizen-Participation Strategy for Health Impact Assessment: Practical Guide

http://www.ncchpp.ca/67/new-publications.ccnpps?id_article=944 (en)
http://www.ccnpps.ca/88/nouvelles-publications.ccnpps?id_article=943 (fr)

The 12th International Conference on Health Impact Assessment (HIA): New issues arising from the evolution of the practice - Summary of Discussions

http://www.ncchpp.ca/67/new-publications.ccnpps?id_article=968 (en)
http://www.ccnpps.ca/88/nouvelles-publications.ccnpps?id_article=967 (fr)

30 October 2013

IAIA14 Impact Assessment for Social and Economic Development

34th Annual Conference of the International Association for Impact Assessment
8-11 April 2014 | Enjoy, Casino & Resort, Hotel del Mar | Viña del Mar, Chile
Opportunities for students described in the attached flyer

Abstracts for both paper and poster submissions are invited through 6 December 2013.  For more information and to sign up to receive updates about this conference please visit www.iaia.org/iaia14.  IAIA conferences are interdisciplinary, and more than 800 delegates from over 80 nations are expected to attend.

During IAIA14, participants will be encouraged to discuss how the various instruments of impact assessment can assist developers, industry, decision-makers, financial institutions, development cooperation providers, and the public to integrate environmental, social, and other concerns in the following areas of interest:

  • Cultural heritage
  • Public participation
  • Social conflict
  • Sustainable development
  • SEA/EIA in Latin America
  • Indigenous peoples
  • Governance
  • Biodiversity
  • Climate change
  • Land use planning and management
  • Agriculture, forestry and fisheries
  • Natural disasters
  • Environmental management systems
  • Health impact assessment
  • Social impact assessment
  • Strategic environmental assessment
  • Environmental IA law, policies and practice
  • Capacity building for better IA systems
  • EIA methodology and practice
  • Monitoring and follow-up
  • Environmental compliance and enforcement
  • Communication in impact assessment
  • Evaluation and evolution of national EIA systems

Many more topics are proposed,  along with training courses, technical visits, and networking opportunities.

For more information, abstracts submission, updates and registration, go to www.iaia.org/iaia14.   We hope to see you in Chile!

22 October 2013

Janette Sadik-Khan: To revitalise planning try new things that are cheap

New York's Transportation Commissioner on what NYC has done to try to change street life, via Francesca in the LinkedIn group.

16 October 2013

Bulletin politiques publiques et santé, le 7 octobre 2013


L'Association de santé publique de la Colombie-Britannique tiendra cette conférence régionale, ainsi qu’une séance avec le Ministère de la Santé sur les priorités émergentes en santé, les 4 et 5 novembre 2013, à Victoria.

Le programme de la réunion de l'American Public Health Association aborde les questions actuelles et émergentes en science, politique etpratique de la santé dans le but de prévenir les maladies et promouvoir la santé. L’événement aura lieu du 2 au 6 novembre 2013, à Boston.


Ce numéro d’octobre 2013 du bulletin « Investir pour l’avenir » porte sur les politiques publiques. On y présente notamment des outils pour promouvoir les saines habitudes de vie, des évaluations d’impact sur la santé pour soutenir les municipalités en Montérégie, des outils pratiques pour améliorer l’offre alimentaire dans les écoles dans le Centre-du-Québec, etc.

10 October 2013

How does HIA bring change?

A guest post from Jonathan Heller from the Human Impact Partners From the HIP blog:
There is a dirty little secret among HIA practitioners: We don’t all agree about what makes the work we are doing effective and about how doing HIA will lead to change. This became clear to me during conversations that started during the “Advocacy and Objectivity in HIA” panel at HIA of the Americas earlier this year. But these differences crystalized for me flying home last week from the National HIA Meeting
The terms advocacy, bias and subjective have been thrown around a lot lately in the HIA field – terms that reveal deep differences among practitioners. I think there are at least three distinct theories of change held among our community. 
1. Data alone.  Subscribers to this theory of change believe all HIA practitioners need to do is to provide decision makers with data about health and health disparities. Armed with that data, decision makers will make better decisions.
2. Data and consensus. Subscribers to this theory believe that the best way to make change is to reach out to stakeholders with diverse views, which usually include community members and, depending on the HIA, could include people from different agencies, project proponents, and decision makers from across the political spectrum. With data and good facilitation, consensus can be reached regarding the impacts, recommendations, and report. That process and the findings will lead to decision makers making better decisions.
3. Data and Power. Subscribers to this theory believe that change is most likely to come from strong data combined with an HIA process that is used to build power in disenfranchised communities that face inequities. With this increased power and strong data, the voices of those most impacted will be heard and decision makers will make better decisions. 
Each of these theories has its merit and each may have its time and place. Each has examples it can hold up that show that it leads to decisions that improve health.
But, in our experience, if HIA is really a tool to achieve health and reduce inequities, combining data and power is the most effective way of getting there. History shows that the other two are challenging ways to truly change policies, plans, and projects that create inequities, especially if those in power don’t have the will to do so or if there is ideological tension around the proposal my ding. Those in power, in favor of a status quo that benefits them and is harming the disenfranchised, are simply not willing to yield power in the face of mere data.  And the compromises that result from consensus building between those who have power and those who do not usually support at best a middle ground that does not significantly benefit those most harmfully effected by decisions.
This is why at Human Impact Partners we do our HIAs in partnership with community organizing groups whose focus is building leadership in low-income communities and communities of color, lifting the voices of populations left out of decision-making discourse, and building the power of those communities.  
We know the data and power theory works. With our partners, we’ve used it over the last couple of years to win over $40 million in affordable housing in South Los Angeles (our USC and Farmers FieldHIAs), substantial increases in funds for alternatives to incarceration in Republican-controlled Wisconsin, and better policies for racial integration of schools in Minnesota. We’ve used it to raise awareness about the harmful impacts of detentions and deportations on immigrant children and families. And, through those processes, we’ve left behind not just awareness and better policies, but more importantly, a community that is more engaged in our democracy and more empowered to fight on their own behalf in the future.
In Closing the Gap in a Generation, the World Health Organization Commission on the Social Determinants of Health declared: “Any serious effort to reduce health inequities will involve changing the distribution of power within society and global regions, empowering individuals and groups to represent strongly and effectively their needs and interests and, in so doing, to challenge and change the unfair and steeply graded distribution of social resources (the conditions for health) to which all, as citizens, have claims and rights.” The great Brazilian philosopher and educator Paulo Freire said it more simply: “Washing one's hands of the conflict between the powerful and the powerless means to side with the powerful, not to be neutral."

9 October 2013

Health Impact Assessments in Australia and New Zealand 2005-2009

Overview of HIAs in Australia and New Zealand during the study period
I'm excited that several colleagues and I have published a paper on HIAs conducted in Australia and New Zealand between 2005 and 2009:

This paper is essentially a census of practice. It's the first paper from an Australian Research Council-funded study of the impact and effectiveness of HIAs conducted in Australia and New Zealand. The best thing is it's an open access publication, so anyone can access the entire article for free.

The flow chart below gives an overview of how HIAs were selected for inclusion in the study. We don't think we included every HIA done - a number were not possible to find or were never publicly released - but the study represents one of the more systematic and comprehensive attempts to describe HIA practice internationally.

A total of 115 potentially eligible HIAs were identified; 55 met the study's inclusion criteria
Please let us know what you think in the comments.

25 September 2013

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24 September 2013

Follow the 2nd Annual U.S. National HIA Meeting at #NatHIA13

The Second Annual U.S. National Health Impact Assessment Meeting is taking place in Washington from 24-26 September. You can follow along using the #NatHIA13 hashtag on Twitter - join the discussion!

16 September 2013

International HIA Conference, Geneva, 2-4 October - Book Now

Dear fellow HIA practitioners, esteemed colleagues and friends, 

I have the great pleasure in informing you about the 13th International Conference on Health Impact Assessment which is being held in Geneva, Switzerland between 2 to 4 October 2013. 

This event is being co-hosted by the University of Geneva, WHO and Health Promotion Switzerland. 

This is an important opportunity for the HIA community to come together and take stock of recent progress with HIA uptake and utilization in different policy and development related contexts. 

Particular focus will be given to the role of HIA as an instrument in facilitating the attainment of Health in All Policies objectives agreed to at the 8th World Conference on Health Promotion which took place in Helsinki in June of this year. 

Conference participants will include impact assessment practitioners, representatives of academic institutions, and some individuals from government agencies charged with commissioning and oversight of health impact assessment activities. 

For more details about the conference, see here a link to the website which contains more information about the programme, registration process, and invited speakers 

I look forward to seeing you there!

Regards and best wishes, 
Carlos Dora, MD, PhD. 
Co-ordinator Public Health and the Environment Department 
World Health Organization Switzerland

The full conference URL is http://www.unige.ch/medecine/eis2013/Programme_en.html

12 September 2013

The application of Equator Principles in high-income OECD countries

Map of the Ichthys LNG Project Area
in North West Australia
There's a very interesting post by Mehrdad Nazari about the use of the Equator Principles and related performance standards in an Australian setting:

The Equator Principles website highlights that “Designated Countries [such as Australia and other high income OECD countries] are those countries deemed to have robust environmental and social governance, legislation systems and institutional capacity designed to protect their people and the natural environment”. The EPIII also notes that for “Projects located in Designated Countries, the Assessment process evaluates compliance with relevant host country laws, regulations and permits that pertain to environmental and social issues”. In the preceding paragraph, the EPIII highlights that for “Projects located in Non-Designated Countries, the Assessment process evaluates compliance with the then applicable IFC Performance Standards on Environmental and Social Sustainability (Performance Standards) and the World Bank Group Environmental, Health and Safety Guidelines (EHS Guidelines) (Exhibit III).”
Despite the proponents in the Ichthys LNG Project reportedly used the EPIII performance standards in an Australian context. Read the post in full here.

Speaking in a purely personal capacity I'd like to see more use of the Equator Principles in developed countries. They're rigorous and well-understood internationally, and can help to allay international investor concerns and facilitate due diligence on a project. An excellent point is made in the comments for Mehrdad's piece:
Although Australia is a developed country, projects like this are usually situated in remote areas which have many of the same characteristics as developing nations: delicate & untouched environment, indigenous traditional landowners, etc. Local laws regulate these issues but, by hedging its bets, the bank does not have to due diligence local law to the same extent – and the syndicate’s lawyers don’t have to convince 41 credit committees.
Thanks to Martin Birley for alerting me to the piece.

6 September 2013

Integrating Health in Impact Assessment: opportunities for Health Promotion post 2015

IAIA members together with WHO Europe and the European Public Health Association (EUPHA) have conducted a research about “Health Inclusion in Impact Assessment”. The preliminary findings were presented in Calgary at IAIA2013 to other Impact Assessment practitioners. This joint discussion further refined the papers, the overall conclusions, and recommendations on the way forward. The final publication will be available on all Institutions websites in the coming months. In the mean time we present a poster at the 8th European Congress on Tropical Medicine and International Health, starting next week in Copenhagen. The poster focuses on the role that Impact Assessment can play in the post 2015 agenda. This is a crucial time when new global sustainable goals are under scrutiny and discussion. The Final Report of the Global Thematic Consultation on Health states that “Health is central to sustainable development: health is a beneficiary of development, a contributor to development, and a key indicator of what people-centred, rights-based, inclusive, and equitable development seeks to achieve.” In this new post 2015 development framework the contributions of other sectors to health and wellbeing are clearly articulated. Impact Assessment is the existing and widely accepted process which can be applied to all sectoral policies, programs, and projects in order to secure health, minimize health risks, and maximize health opportunities.

8 August 2013

The value of professional association


Some/many of you will know that I have recently become co-chair of the HIA/Health Section of the IAIA (International Association for Impact Assessment). I did so reluctantly because I don’t know if I can give it the time it needs. In the end I accepted because I believe in what the IAIA stands for and what, in particular, the group of HIA Practitioners in the HIA/Health Section of IAIA are thinking and are doing (though I don’t necessarily always agree with every perspective). I like them and I consider some/many of them friends as well as colleagues.

I would like to take some of your valuable time and relate to you a story of my involvement in professional associations and why I think you should seriously consider joining IAIA. www.iaia.org

I was a passionate member/advocate of the UKPHA (UK Public Health Association) I joined UKPHA in 2003-04 as a corporate member (via my then very small independent consultancy Living Knowledge). I was very disappointed and quite frustrated that the Trustees of UKPHA did not see the funding crunch coming so that in the end the only way forward was for UKPHA to close (okay it merged with the Faculty of Public Health but for me it closed). I still think that was and is a big shame.

I have nothing against the UK Faculty of Public Health but ultimately FPH and the UK Royal Society of Public Health (of which I have also until this year been a long standing Fellow) have not been as good a fit in my professional development as I had hoped. At this stage in my (professional) life I don’t feel the need/value of being linked to associations where I don’t really get much from my membership apart from saying I am a member. Partly/mostly people can legitimately say this is down to me, you only get out of these associations what you put in. But I think it is also due to the structure and focus of these associations as well, HIA is not a strong focus in them.

Since 2004-05 I have also been a member of IAIA, in fact I met Ben Harris Roxas in Stavanger at an IAIA conference in 2005-ish. He has been a good HIA colleague (dare I say friend) ever since. I have also deepened friendships I have made at the International HIA conference at the Porto IAIA conference more recently.

There is only one international association for HIA that also connects with the other closely related IAs of Environmental and Social Impact Assessment and that is the International Association for Impact Assessment (IAIA).

My enthusiasm for IAIA has waxed and waned and there was a point where my membership lapsed and a point where I seriously considered not being a member. The thing that has kept me renewing my membership  is that sentence above and more recently the, not perfect, but increasingly interesting members-only IAIA Connect network where members can post ideas, issues and thoughts across environment, social and health. They do have a journal IAPA (Impact assessment and Project Appraisal) but I rarely have time to look at it. IAIA Connect and the email updates I get are as interesting and useful as the HIA Group on LinkedIn and the HIAnet email network (perhaps more so).

I find that my £80 a year or so (US$110 is what they charge) is worth it for IAIA Connect, the ethical values that IAIA provides as a benchmark for all Impact Assessors and the sense that I belong to a bigger global Impact Assessment movement/community.


11 July 2013

US HIA call for proposals

NNPHI call for proposals

The National Network of Public Health Institutes has announced a call for proposals. It will award grants to up to two public health institute members to conduct health impact assessments, or HIAs. The support will include training, technical assistance, and travel to the national HIA meeting. NNPHI members who have completed at least one HIA are eligible.

Please read the call for proposals. For more information, see the health in all policies page of the NNPHI website.

Key Dates
  • Wednesday, July 10, 1 p.m. EDT—Information session. Please register.
  • Thursday, July 25—Proposals due to NNPHI.

NACCHO request for applications - Mentors and mentees

The National Association of County and City Health Officials is working to increase the use of HIAs among local health departments by providing peer-to-peer assistance and intensive technical support through a mentorship program. NACCHO is seeking applicants for:
  • Mentors experienced in conducting HIAs. Those selected will receive stipends for their time.
  • Mentees new to the HIA process. Those selected will receive assistance and technical support.
Mentors and mentees will be paired according to technical assistance needs. All interested and eligible local health departments and individuals are encouraged to apply. To read the request for applications, please visit http://www.naccho.org/topics/environmental/landuseplanning/index.cfm.

Key Dates
  • Tuesday, July 16, noon EDT—Information session. Please register.
  • Friday, Aug. 9, 8 p.m. EDT—Mentor applications due.
  • Friday, Aug. 16, 8 p.m. EDT—Mentee applications due.

via Health Impact Project

24 June 2013

USA: Access to paid sick days could reduce influenza

New research, published in the American Journal of Public Health, reveals a reduction in flu cases when access to paid sick days is made available in the workplace. As you might imagine, it would be difficult to quantify the impact of a policy that hasn’t yet been implemented, so the researchers simulated their population of interest—1.2 million “agents” in Allegheny County, in this case—to evaluate the transmission patterns of influenza in workplaces under different scenarios (see below for details of their methods, which may be of interest to HIA researchers).
In a baseline simulation, access to paid sick days was inequitably distributed, as it is in reality. Data from the Bureau of Labor Statistics in the United States shows that only 53% of employees in small workplaces (workplaces with fewer than 50 employees) compared with 85% in large workplaces (workplaces with 500 or more employees) have access to paid sick days. A larger percentage of employees with access to paid sick days stayed home than did employees without paid sick days—both for an average of 1.7 days when sick. They then compared results to the estimated number of flu cases that might result under two alternative scenarios: (1) all employees had access to paid sick days (a universal paid sick days policy); and (2) all employees had access to one or two days when they could stay home from work and be paid to recover from the flu (a “flu days” intervention).
They defined flu days as additional days layered on top of existing paid sick days policies. Flu days were conceptualized as an intervention educating employees to stay home for an additional day over and above what they might anyway. Currently, employees stay home for 1.7 days on average with the flu. With a flu day, they would stay home for 2.7 days on average. In comparison, universal access to paid sick days increases the proportion of people staying home, but (according to their assumptions) does not increase the duration for which employees stay home. In short, universal access to paid sick days increases the probability of workers staying home when ill, and flu days increase the time they spend at home when they are infectious. 
This study found that universal access to paid sick days would reduce flu cases in the workplace by 5.86 percent and a “flu days” intervention would reduce cases by 25.33 percent. Together, universal paid sick days and flu days would equitably and effectively reduce influenza infections in workplaces. The universal paid sick days scenario was estimated to be more effective for small workplaces while “flu days” would lead to fewer flu cases in larger workplaces.
It is as important to test an intervention’s impact on health equity as it is to test its effectiveness. Universal access to paid sick days would enhance equity in the workplace by leveling the playing field in terms of access to resources. Additional interventions that promote employees staying away for more than 1.7 days on average could then be layered on to effectively reduce disease further.
The US Centers for Disease Control and Prevention recommends that people with influenza stay home for 24 hours after their fever has resolved. However, not everyone is able to follow these guidelines--many more workers in small workplaces than in large ones lack access to paid sick days and hence find it difficult to stay home when ill. These simulations show that allowing all workers access to paid sick days would reduce illness due to workplace transmission—fewer workers get the flu over the course of the season if employees are able to stay home and keep the virus from being transmitted to their co-workers. These findings make a strong case for paid sick days. Future research will be examining the economic impacts of workplace policies.
More on the simulation methods
Agent-based modeling was used to simulate the population of Allegheny County so that they could assess the impact of a paid sick days policy. This is a quantitative technique that is becoming increasingly popular among health behavior researchers, and may be useful to HIA researchers as well. In this case, authors of the study used the Framework for Reconstructing Epidemic Dynamics (FRED), a platform developed at the Public Health Dynamics Laboratory, University of Pittsburgh, to simulate the 1.2 million population of the county. Other simpler platforms such as NetLogo have been developed to enable researchers and practitioners to get started with simulating a population of interest.
 A “synthetic population” of Allegheny County was developed by RTI International based on data from the American Community Survey, LandScan USA, and the census; populations for counties and states in the United States and are freely available. This synthetic population ensured that the model reflected reality in ways that were important to this study and to infectious disease spread. For example, agents are assigned to schools or workplaces based on location, size of schools/workplaces, and commuting patterns; and each agent had characteristics including age, sex, race, employment status, household income, and household location. Health information such as health status on each day, infectiousness, and susceptibility were associated with each agent in FRED.
 During each simulated day, children went to school and working adults to work. They interacted with other agents who shared the same social activity locations, and returned home at the end of the day to interact with others at home. Each weekday, this routine repeated. Agents had a probability of disease transmission during interactions with others based on parameters from published studies.

HIA Step by Step - A new online course by the NCCHPP

Health Impact Assessment (HIA) is used to inform decision makers about the potential effects of a project, program or policy on the health of a population. HIA of public policies applies to any project, program or policy for which the decision maker is a governmental authority, either at the local, regional, provincial or federal level.
The NCCHPP will offer a new online continuing education course on HIA of public policies starting this fall.
This 12-hour online course will take place over a period of 3 weeks and will be offered both in French and in English.
This course will allow you to become familiar with the HIA process as applied to public policies, recognize its foundations, and reflect on the favorable conditions for successful HIA implementation.
Dates of the online course:
  • in French from October 15 to November 1st 2013 
  • in English from October 21 to November 8, 2013
Registration deadline: October 7, 2013. Places are limited.
For more information, and to register: click here. (http://www.ncchpp.ca/274/Online_Course.ccnpps?id_article=922) 
For any question concerning this new online course, please contact us at the following address: ncchpp_training@inspq.qc.ca or by phone at 514-864-1600 ext. 3637.

11 June 2013

HIA and peer review satisfaction survey

Request below.

Please help move the practice of HIA and peer review forward with your feedback on this survey (5 minutes).
Survey link (google form): http://goo.gl/DN7Tg
We, a group of HIA practitioners, are interested in your experiences of the peer review process in Health Impact Assessment (HIA), as a reviewer and/or as a reviewee. Although HIA practice is not standardized, many HIA practitioners feel some form of peer review to be important in ensuring quality in the HIA process. Your responses to the survey will:
  • help us understand the broad and multiple practices of peer review
  • inform a paper featuring case studies of how practitioners have incorporated peer review within the HIA framework.
For this survey, peer review is defined broadly to include all purposeful activities that contribute to enhancing the quality of an HIA using peer review and feedback. This could range from an informal gathering of “experts” to review the HIA to a formalized double-blind review facilitated by an academic journal. 
Reviewers might be environmental exposure specialists, community leaders, public officials, or others.Please feel free to share with other colleagues who have been a part of the peer review process in HIA.Deadline for responses - August 1st, 2013
For more information, contact Tim Choi at tim.choi@sfdph.org