16 December 2015

Health impact assessment needs maturity models

Whenever I used to write anything about health impact assessment I started with "HIA it is a new field". That’s no longer the case. People have been grappling with how to make HIAs routine for more than twenty years. This has taken different forms. It’s described as institutionalisation, mandating, capacity-building, integration, harmonisation and even theoretical alignment. People have often conflated quite different HIA activities as the same thing,  complicating things. This led to people talking at cross-purposes.

How to make HIA part of routine practice is really none of these things. It’s about how we get HIA to the next level.

The next level?

What do I mean by this? The next level represents deeper embedding in routine practice. A more sophisticated understanding of when HIA can be useful. A large enough body of practitioners with varying levels of experience.

These challenges apply within countries but also globally.

How do we get from where we are to this next level? We have describe what the current state of practice is (this varies). We also have articulate what our desired future state would be. And then we have to describe what steps lie between.

Maturity models can help us.

Maturity models

Maturity models are quality improvement tools that were first used in information technology. ‘Maturity’ referred to the optimisation of processes, including changes from ad-hoc to formalised arrangements and ongoing quality improvement. This involved describing different levels of maturity across several different domains.

The different domains in a maturity model are usually rated for their maturity:
  1. initial - involves individual heroes, is not well documented and hard to replicate
  2. repeatable - processes are well enough described or understood that they can be repeated
  3. defined - the processes are defined and confirmed
  4. managed - the processes are managed in line with agreed metrics
  5. optimising - process management includes ongoing optimisation and improvement.
In some cases a sixth level is added.  This involves embedding capability across all processes.

What would HIA maturity models include?

HIA maturity models would enable us to think about which domains of maturity matter. These could include:
  • organisational capacity
  • workforce
  • leadership
  • resources and tools
  • resource allocation.
I think use of maturity models would enable more sophisticated thinking about capacity building. It would enable discussions to move beyond their historical focus on regulations and workforce. I've attempted to pull together a draft HIA maturity model below.

This model isn't perfect and it won't be applicable in all settings. It will need to be adapted, changed and maybe even started from scratch. I hope maturity models like it will enable a more nuanced way of thinking about the domains of capacity that are required and to focus activity and investment.

In summary

Maturity models  give systems, organisations and HIA practitioners a better framework for understanding the range of capabilities that we need for HIA to flourish. HIA maturity models would identify:
  • the domains of HIA capability
  • provide a basis for appraising HIA capability, development and performance
  • describe the characteristics of different levels of HIA capability
  • provide a description of what enhanced capability and practice would involve.
I think maturity models represents a promising area of practical and conceptual development for HIA. I'm interested in what you think.

27 August 2015

Short HIA training course: gauging interes

From Marla Orenstein from Habitat Health Impact Consulting:

We are currently trying to gauge the level of interest in having a short HIA training workshop (2-3 days) held in different cities — possibly including yours!  We have developed a very brief survey to help us find out where there might be interest.  If you or anyone from your organization might be interested in a short HIA training workshop, we would really, really appreciate it if you would fill this survey out.  It would also be enormously helpful if you could pass the message along to anyone else who you think might be interested.  The survey takes under 3 minutes to complete.
The survey can be accessed here: https://ardethevans.typeform.com/to/Qinesx

31 July 2015

HIA of transport projects for Plaine Commune

Download the report
An English summary of the Plaine Commune HIA of transport projects has been developed. It describes an HIA of three related transport projects in the Saint-Denis area of Paris.

You can download the report here.

16 July 2015

APHA summer webinar series about racism's impact on health and disparities in the USA

The recent events in Charleston, South Caroline, Baltimore, Maryland, and Ferguson, Missouri, remind us that stigma, inequalities and civil rights injustices remain in our society today. Unfortunately, skin color plays a large part in how people are viewed, valued and treated. We know that racism, both intentional and unintentional, affects the health and well-being of individuals and communities and stifles the opportunity of many to contribute fully to the future and growth of this nation.

Join the leadership of the American Public Health Association in a summer webinar series about racism's impact on health and disparities. This a four part webinar series.

Register by clicking here.

Naming and Addressing Racism: A Primer

July 21, 2015 | 2 p.m. EDT

Use timeanddate.com to find the time in your timezone.

Shiriki Kumanyika, PhD, MPH, and Camara P. Jones, MD, MPH, PhD 

This kick-off webinar featuring APHA’s executive director, president and president-elect will take a look at some of the nation’s leading health inequities.

APHA President Shiriki Kumanyika will discuss how racism is one of the most challenging tools of social stratification we face when trying to improve the health of the public. She also will reflect on the evidence and research needs related to how racism limits our ability to make America the healthiest nation.

APHA President-Elect Camara Jones will tell the Gardener's Tale and present a framework for understanding racism on three levels. This framework is useful for understanding the basis for race-associated differences in health, designing effective interventions to eliminate those differences and engaging in a national conversation.

Upcoming webinars in this series:

Community Violence Well-Being
August 4, 2015, 2 p.m. EDT

Unequal Treatment: Disparities in Access, Quality and Care
August 18, 2015, 2 p.m. EDT

Racism: The Silent Partner in High School Dropout and Health Disparities
September 1, 2015, 2 p.m. EDT

14 July 2015

United Nations Development Program (UNDP) Global Roster of Environmental, Social and Health Expert Consultants

UNDP is establishing a global roster of expert consultants to support implementation of our Social and Environmental Standards (SES), deadline for applications is Friday, August 7:



UNDP’s Social and Environmental Standards (SES) underpin our commitment to mainstream social and environmental sustainability in our Programmes and Projects to support sustainable development.

The objectives of the standards are to:
Strengthen the social and environmental outcomes of Programmes and Projects;
Avoid adverse impacts to people and the environment;
Minimize, mitigate, and manage adverse impacts where avoidance is not possible;
Strengthen UNDP and partner capacities for managing social and environmental risks;
Ensure full and effective stakeholder engagement, including through a mechanism to respond to complaints from project-affected people.

The SES are comprised of an Overarching Policy and Principles, Project-Level Standards, and a Policy Delivery Process. The overarching policy and principles at the core of the SES are: (i) human rights-based approach to development programming; (ii) gender equality; and (iii) environmental sustainability.

A key mechanism to ensure these standards are applied is through UNDP’s project-level Social and Environmental Screening Procedure (SESP) which is a requirement for all proposed projects with a budget of $500,000 or more. The objectives of the SESP are to: (a) Integrate the SES Overarching Principles (human rights, gender equality and environmental sustainability); (b) Identify potential social and environmental risks and their significance; (c) Determine the Project's risk category (Low, Moderate, High); and (d) Determine the level of social and environmental assessment and management required to address potential risks and impacts.

UNDP’s SES and SESP came into effect January 1, 2015. The challenge now is to ensure successful implementation and strengthened capacities of staff to apply the standards.

Duties and Responsibilities (if selected to be on the roster and then selected for an assignment

To support implementation of the SES a Roster of Social and Environmental Standards Experts will be established. Experts will need to demonstrate extensive experience in at least one (preferably multiple) of the thematic areas listed below:
  • Human Rights (including human rights based approach and human rights impact assessment);
  • Gender Equality and Women’s Empowerment (including gender mainstreaming and gender analysis);
  • Biodiversity Conservation and Sustainable Natural Resource Management (including mitigation and use of offsets, protected areas, forests, water);
  • Climate Change and Disaster Risk Reduction (including climate risk analysis, disaster risk, greenhouse gas emissions);
  • Community Health and Safety (including infrastructure safety, health impacts, emergency preparedness);
  • Labour Standards (including familiarity with ILO standards, decent work);
  • Cultural Heritage (including chance find procedures, physical and intangible cultural resources);
  • Displacement and Resettlement (including Resettlement Action Plan, livelihoods);
  • Indigenous Peoples (including Free, Prior and Informed Consent, Indigenous Peoples Plans);
  • Pollution Prevention and Resource Efficiency (including pollution prevention plans, waste management, hazardous materials);
  • Social and Environmental Screening and Assessment (including Environmental and Social Impact Assessment, Strategic Environmental and Social Assessment, Environmental and Social Management Plans).
Relevant experience includes demonstrated familiarity with the relevant UN international legal and normative framework, the application of relevant standards, stakeholder engagement, analytical tools, methods, impact assessment and risk management measures during the planning and implementation of development projects.

The duties and responsibilities detailed below are a representative, but not exhaustive, list of potential activities.

Specific Terms of Reference will dictate the scope of work and the selection of experts from the vetted roster for each of the assignments. Key areas of support and activities will include:

Development of guidance and tools
  • Provide inputs in area(s) of expertise to the development of guidance and tools to support implementation of the SES;
  • Support the elaboration of case studies;
Capacity development and trainings for staff
  • Support the development and delivery of trainings for staff, including webinars, the development of online training content, and support to face-to-face trainings;
  • Support the development of learning materials, including case studies and documentation of lessons learned.
  • Technical and advisory support related to implementation of the SES
  • Review draft SESP reports and related assessments and management plans and provide advice on how to further strengthen the quality.
  • Support the conduct of assessments and development of management plans.
  • Support implementation and monitoring of management and mitigation activities.
  • Institutional arrangements will be agreed if a contract is formalized. The hired consultants will report to, seek approval/acceptance of outputs as specified in the contract.

Duration of the Work: (If selected for roster and then selected for a specific project)

One year initial with possibility of extension up to two additional years subject to satisfactory performance. 

  • Specific technical expertise in at least one of the SES thematic areas listed above;
  • Highly organized with strong analytical and research skills;
  • Excellent analytical, writing, advocacy, presentation, and communications skills;
  • Ability to prepare succinct, analytical publications and reports;
  • Focuses on impact and result for the client and responds positively to critical feedback;
  • Demonstrated ability to work in an independent manner.

Required Skills and Experience

  • Masters degree in field related to international development, with specific academic background related to social and environmental sustainability.

  • At least 10 years of experience related to social and environmental standards and impact assessment in an international development context;
  • Experience developing and conducting training related to social and environmental standards;
  • Experience or strong familiarity with the work of UNDP and/or other multilateral, bilateral and civil society development partners.
  • Familiarity with the UN System, in particular UNDP.

7 July 2015

Is there evidence that walking groups have health benefits? A systematic review and meta-analysis

Is there evidence that walking groups have health benefits? A systematic review and meta-analysis

Sarah Hanson, Andy Jones
9 November 2014

Regular physical activity positively impacts health potentially offering similar effects to some drug interventions in terms of mortality benefits. Indeed, it has been suggested as an alternative or adjunct to conventional drug therapy. Walking at a pace of 3–5 m/h (5–8 km/h) expends sufficient energy to be classified as moderate intensity2 and is an easy and accessible way of meeting physical activity recommendations.

Systematic reviews and meta-analyses have shown walking to have various health benefits including:

  • positive effects on fitness
  • fatness and resting blood pressure
  • blood pressure control
  • weight loss
  • depression
  • cardiovascular disease risk prevention.


To assess the health benefits of outdoor walking groups.

Systematic review and meta-analysis of walking group interventions examining differences in commonly used physiological, psychological and well-being outcomes between baseline and intervention end.

Data sources
Seven electronic databases, clinical trial registers, grey literature and reference lists in English language up to November 2013.

Eligibility criteria
Adults, group walking outdoors with outcomes directly attributable to the walking intervention.

Forty-two studies were identified involving 1843 participants. There is evidence that walking groups have wide-ranging health benefits. Meta-analysis showed statistically significant reductions in mean difference for systolic blood pressure −3.72 mm Hg (−5.28 to −2.17) and diastolic blood pressure −3.14 mm Hg (−4.15 to −2.13); resting heart rate −2.88 bpm (−4.13 to −1.64); body fat −1.31% (−2.10 to −0.52), body mass index −0.71 kg/m2 (−1.19 to −0.23), total cholesterol −0.11 mmol/L (−0.22 to −0.01) and statistically significant mean increases in VO2max of 2.66 mL/kg/min (1.67 3.65), the SF-36 (physical functioning) score 6.02 (0.51 to 11.53) and a 6 min walk time of 79.6 m (53.37–105.84).

A standardised mean difference showed a reduction in depression scores with an effect size of −0.67 (−0.97 to −0.38). The evidence was less clear for other
outcomes such as waist circumference fasting glucose, SF-36 (mental health) and serum lipids such as highdensity lipids. There were no notable adverse side effects reported in any of the studies.

Walking groups are effective and safe with good adherence and wide-ranging health benefits. They could be a promising intervention as an adjunct to other healthcare or as a proactive health-promoting activity.

Original Source BJSM

4 July 2015

Does active commuting improve psychological wellbeing?

Does active commuting improve psychological wellbeing?
Longitudinal evidence from eighteen waves of the British Household Panel Survey

Adam Martin, Yevgeniy Goryakin, Marc Suhrcke



The aim of this study is to explore the relationship between active travel and psychological wellbeing.

  • Impact of commuting behaviour on wellbeing was explored using individual fixed effects analyses.
  • Compared to driving, wellbeing was higher when using active travel or public transport.
  • Use of active travel reduced the likelihood of two specific GHQ12 psychological symptoms.
  • Switching from car driving to active travel improved wellbeing.
  • Wellbeing increased with travel time for walkers, but decreased for drivers.


The aim of this study is to explore the relationship between active travel and psychological wellbeing.


This study used data on 17,985 adult commuters in eighteen waves of the British Household Panel Survey (1991/2–2008/9). Fixed effects regression models were used to investigate how travel mode choice, commuting time and switching to  active travel impacted on overall psychological wellbeing and how (iv.) travel mode choice impacted on specific psychological symptoms included in the General Health Questionnaire.


After accounting for changes in individual-level socioeconomic characteristics and potential confounding variables relating to work, residence and health, significant associations were observed between overall psychological wellbeing (on a 36-point Likert scale) and (i.) active travel (0.185, 95% CI: 0.048 to 0.321) and public transport (0.195, 95% CI: 0.035 to 0.355) when compared to car travel, (ii.) time spent (per 10 minute change) walking (0.083, 95% CI: 0.003 to 0.163) and driving (−0.033, 95% CI: −0.064 to −0.001), and (iii.) switching from car travel to active travel (0.479, 95% CI: 0.199 to 0.758). Active travel was also associated with reductions in the odds of experiencing two specific psychological symptoms when compared to car travel.


The positive psychological wellbeing effects identified in this study should be considered in cost–benefit assessments of interventions seeking to promote active travel

Full article click here (Open Access)

Original source  Michael Evans

9 June 2015

Presentations from the Health in all Policies New Zealand Conference 2015

For those of us who could not make it to New Zealand below is the next best thing, pdfs of the conference programme and the main presentations.
Health in all Policies New Zealand Conference 2015 Programme
What is Health in All Policies?
Rob Quigley
Sugary Drinks and Public Policy
Dr Rob Beaglehole
Human Rights and HIA
Dr Fiona Haigh (University of New South Wales, Australia)
Health impact assessment (HIA) and human rights both contribute to the promotion of physical and mental health and wellbeing. Human rights provide an ethical and legal framework, while HIA provides evidence-based methods and tools, derived from social and natural sciences, for policy evaluation. Scholars have proposed that international human rights laws and standards provide a legally binding and morally compelling framework for
HIA. Several human rights monitoring mechanisms – including the UN Committee on the Rights of the Child, the UN Committee on Economic, Social and Cultural Rights and the UN Special Rapporteur on the right to health – have called on governments to perform human rights-based impact assessments. It has been hypothesized that HIA can provide a well established evidence based (scientific) method to systematically and transparently assess impacts on the right to health; while human rights contribute a legally binding and morally compelling framework that allows governments and governmental agencies to be held accountable drawing attention to the legal and policy context within which health interventions occur. Despite increasing attention given to human rights and health by policy makers and researchers little has been achieved to date when it comes to integrating human rights considerations into HIA work. Thus, there are few methodologies and tools developed to identify and trace the context specific pathways between a policy, human rights and health outcomes; explain why relationships between these exist or what 'mechanisms' might account for them. In the absence of such explanations it is difficult to decide 'what to do' to improve human rights and health outcomes.
This presentation explores integrating human rights into Health Impact Assessment (HIA) methodology. In particular we report on research examining the fit between HIA and human rights, how HRHIA could work and what are the implications of integrating human rights into Health Impact Assessment (HIA) methodology.
Pegasus Health the Evolution of Primary Care and Health in All Policies
Emeritus Professor Andrew Hornblow
Trading Away Health: A Health Impact Assessment of the Trans Pacific Trade Agreement
Dr Patrick Harris and Fiona Haigh
Good policy-making requires good science
Professor Sir Peter Gluckman
Relationships are the currency of the future
Ana Apatu and Henare O’Keefe
Introduction: Where to now
Mary Richardson
Mind the Gap
Associate Professor Susan Morton
A Canterbury That’s More Than Just All Right...
Dr Lucy D'Aeth
Te Ara Mua Future Streets: Engaging Communities and Challenging Polices
Dr Adrian Field and Dr Alex Macmillan
Over half of the world’s population and three quarters of OECD residents now live in cities. In the last century, New Zealand’s towns and urban areas grew seven-fold while the rural population grew very little. Cities in New Zealand and internationally are at the frontline of addressing public health and environmental sustainability. Concerted and integrated responses from planning, urban design and public health are key to securing an urban form the meets the challenges of cities in the 21st century.
Transport infrastructure poses a particular challenge, where the dominant paradigm often has the private car as is its centrepiece. Transport infrastructure investments also emphasise economic and safety gains while largely ignoring other public health, social and environmental impacts, including impacts on social and health equity. The ideas and thinking that have shaped transport infrastructure have contributed to such global health problems as obesity and social dislocation.
Interventions to re-shape or retrofit existing urban communities can have multiple co-benefits for social, physical, economic and environmental wellbeing, and increasing community resilience to expected future threats. Creating urban form for people rather than cars, improves people’s health, improves perceptions of safety, improves opportunities for physical activity and helps slow the growth of long-term conditions.
Te Ara Mua – Future Streets is a mixed methods intervention study of suburb-wide street changes aimed at making cycling and walking safer and more attractive in Mangere, Auckland.
The project, led by a consortium of universities and consultancies, in partnership with Auckland Transport and New Zealand Transport Agency, brings in leading international thinking in street design, allied with an intensive participatory design process. Te Ara Mua will offer new approaches to design, apply a participatory engagement approach in which knowledge is shared, and look to challenge the ways in which the costs and benefits of street infrastructure are measured, and how these in turn inform policy.
This pecha kucha presentation highlights the contribution that the Te Ara Mua – Future Streets project makes to applying Health In All Policies philosophy at a local level, in a way that challenges established thinking in urban form.
Economic Perspectives on Health in All Policies
Professor Paul Dalziel
The Cancer Society: Long Term Plans, Pathway to Smokefree New Zealand by 2025
Martin Witt and Amanda Dodd
Video component of the presentation by Martin Witt and Amanda Dodd
As a community based organisation, the Cancer Society has anestablished a suite of health promotion programmes designed to raise awareness of lifestyle and cancer risk. Over the last five years the organisation has placed a focus the role of public policy can play in achieving positive health outcomes for our communities. In particular our tobacco control work has placed importance on partnerships with local authorities and other key partners, to facilitate creation of smokefree community spaces. As key steps toward achieving the Smokefree Aotearoa goal by 2025 extending the scope of these policies to go beyond the “greenspace” is essential. Public support for more Smokefree community spaces is strong and there are encouraging signs that other key stakeholders such as businesses are open to further discussions but what do councils think?
With ten years to go to the goal, it is significant that councils are now developing their Long Term Plans [LTP] for the same period offering a timely opportunity for current partnerships to be strengthened. This presentation will outline how the Cancer Society is supporting a Health in All Policies approach, working in partnership to frame the need for councils to demonstrate commitment and leadership in helping ensure that New Zealand does indeed achieve its goal to be Smokefree by 2025. The presentation will address how criteria have been developed to assess the extent to which councils acknowledge their role in promoting Smokefree policy and
how this might develop over the next few years. Council responses to submissions will be evaluated against these criteria.
Although there are examples of councils already demonstrating strategies consistent with the 2025 goal, most notably Auckland and Palmerston North , there need to be much stronger signs that other councils recognise the significance of their role; a role that does not mean a large financial commitment. LTP are by their nature based on the use of limited resources, however they are also open to public consultation and intended to be an outline of all council activities that help make communities safe places to live work and play in. Failure to engage councils in the 2025 goal as part of their LTP’s in 2015 would seem to be inconsistent with that intention.
Transport and Health in All Policies
Dr Alex Macmillan
Transport policy has a strong and complex influence on population health, social and health equity, and environmental sustainability, which underpins human health. Currently in New Zealand, transport policy objectives are heavily focused on supporting economic growth through congestion reduction and freight movement, while addressing road traffic injury. Although some attempts have been made to incorporate wider public health objectives into transport planning more recently, these have been hampered by knowledge, skills, institutional and ideological barriers. Using more than a decade of experience with influencing transport policy using an arsenal of approaches, I will explore how successful this influence has been and the factors underpinning more and less successful influence. I will also draw together some insights from this experience for Health in all Policies more generally.
View the presentations from the Reflective Practice Day on 30th April 2015

Original Source: Healthy Christchurch

29 May 2015

Free Webinar - Building Bridges between Transportation and Health

Building Bridges between Transportation and Health

Meeting Description:

This webinar will discuss the connection between transportation and health and give insight into the specific process one community used to fund programs and how the programs are implemented from start to finish. It will also highlight how advocacy and community organizing are used to move projects forward.

To register click here

Wed, Jun 3, 2015

02:00 PM EDT

1 hour

American Public Health Association

Moderator:  Megan Wier, MPH
(Lead Staff, Health, Transportation and Equity at San Francisco Department of Public Health)


Leslie Meehan, AICP
(Director of Healthy Communities, Nashville Area Metropolitan Planning Organization)

Leslie will provide an overview of the process used to incorporate health into transportation planning, policy, funding, data collection and measurement in the greater Nashville region.  She will provide information on how the MPO evaluates and prioritizes projects by health and equity, and how health data is used to predict population-level changes in health outcomes from increased active travel.

Scott Bricker
(Executive Director, America Walks)
Scott will discuss advocacy and community organizing as tools to move projects forward. He will provide examples of communities that have improved walkability and active transportation through organized efforts.

23 April 2015

Why was NIAP so Successful?


Key URL for documents published by NIAP:

What were the important drivers for success?
Funded posts in EPA and Planning Division at local government level to support and help coordinate the relationships and the work of the programme.
Devolution was an important driver as states had to put a policies, guidance and system in place.
Environmental, social and economic problems were also drivers.
The legal and procedures are in place but too early to say how it is working. Anecdotal evidence that yes it is being used. This is likely to be because of the way the material was developed, co-production.
A new generation of young professionals.

BUT some things didn't work e.g. establishing a professional association.