Health in Impact Assessments: Opportunities not to be missed

"Health in Impact Assessments: Opportunities not to be missed" is a new joint publication from WHO Europe, EUPHA, and IAIA.

Prospective impact assessment is a consolidated approach for pursuing foresight in policy and decision-making, systematically deployed worldwide. There is consensus that, even in well developed impact assessments, human health is not always covered adequately. Partly as a response, health impact assessment (HIA) has emerged and has been applied in several countries in Europe and beyond. Opinions about the merits of HIA separate from other forms of impact assessment differ. This publication aims to provide a detailed and balanced view on "health in impact assessments". Five key types of impact assessment, namely environmental impact assessment, strategic environmental assessment, social impact assessment, sustainability assessment, and HIA are presented, and four key questions are discussed: How can the various assessments contribute to promoting and protecting human health? How can further integration of health support the various forms of impact assessments? What forms of integration seem advisable? What priorities for further development? This analysis suggests that the potential of impact assessments to protect and promote health is underutilized, and represents a missed opportunity. Ways need to be found to exploit the potential to a fuller extent

This publication is available at: http://www.euro.who.int/health-in-IA

Request for Expressions of Interest: Short term WHO consultancy

Short term consultancy to develop guidance and training materials on addressing health in environmental impact assessments - with a specific application on mining projects

World Health Organization, Geneva, Switzerland 

WHO is implementing a project to develop global guidance on ensuring adequate coverage of health issues as part of environmental impact assessment s (EIA) undertaken on mining projects.

Provisions related to the coverage of human health issues are included within environmental assessment regulations in many countries. In practice, however, coverage of health within EIA is often limited and predominantly only addresses physical environmental considerations (e.g. air, water soil and pollution/emissions related issues). Other factors that influence health, for example related to the social and human environment, are not often included or are considered separately as part of other types of assessments. The resulting picture of health that emerges can therefore be incomplete.

The overall aim of the WHO initiative is to enhance coverage of health in environmental impact assessment, in particular through the development of WHO guidance materials on health in EIA and through the development of training materials for environmental assessment regulators and their health sector counterparts.

WHO seeks an independent consultant(s) to support the above.

The Scope of Work for this consultancy consists of the following tasks:

1. Conduct a literature review of existing materials (including training materials) on health in environmental impact assessment. The primary focus will be on project level application of health in EIA and on the analysis of the extent to which health issues (and health determinants) are covered in current EIA practice. Key enabling factors and barriers influencing coverage of health in EIA should also be considered. To the extent possible, this literature review should take stock of publications available in multiple languages and reflective of experiences/practices in different regions around the world.

2. Develop three (3) guidance notes on health in EIA. These guidance notes should be formulated on the basis of the findings of the above literature review, and on the expertise and experience of the consultant. One of the guidance notes should be oriented towards environmental and health impact assessment regulators - i.e. those responsible for quality control of impact assessments undertaken; one should be orientated towards impact assessment practitioners; and one should be orientated towards project proponents - or entities that would normally commission an impact assessment study.

3. Develop training materials on health in EIA, based on the above guidance notes and on the findings of the literature review. These training materials should take the form of a 3 day course for environmental and health impact assessment regulatory authorities and should address issues related to the quality of coverage of health issues (i.e. what adequate health impact assessments should look like), as well as process related considerations (i.e. how and at what points in the EIA process health issues should be considered). Guidance on evaluation of core competencies of impact assessment practitioners should also be included. 

4. Delivery of the training materials/course in a low to middle income country host to large scale mining activities. Case examples used as pilot training should be based on actual examples from the pilot country. (A national consultant will be engaged to assist with the adaptation of both the guidance notes and training materials, including oversight of translation activities).

5. Updating of the training materials based on feedback from the course participants. 

6. Development of a case study based on the pilot - i.e. documenting lessons learned and
insights from the country experience.

Expected deliverables include: 

• Report detailing results of the initial literature review.
• Guidance notes on health in EIA: one for regulators, one for practitioners, and one for project proponents.
• Training materials on health in EIA, which should include presentations, participant materials, training/instructor materials, and case examples for use in practical exercises.
• Case study of the experience and lessons learned from the pilot. 

The World Health Organization Headquarters Offices in Geneva now invites eligible individuals firms/to indicate their interest in undertaking this work. Interested parties must provide information indicating that they are qualified to perform the above tasks: curriculum vitae, description of similar assignments, experience in similar conditions, examples of relevant reports or publications, etc. The consultant(s) will be selected through a competitive process in accordance with WHO's operating policies and procedures on procurement of services.

The expected start date of this consultancy is 01 June 2014 (or as soon as reasonably possible after that). The training activities are expected to be piloted in Q3 of 2014.

The consultancy will largely be home-based, apart from travel required to deliver the pilot training course.

The consultant will be remunerated at a daily rate that is commensurate with his/her experience and based on the UN common salary scale.

Qualifications and Experiences required: 

• Advanced university degree in public health or a related field. 
• At least 7 (seven) years of international experience working on public health and 
• development issues; 
• Demonstrated experience with the conduct of HIAs and/or integrated EIAs on mining 
• projects; 
• Experienced trainer and facilitator with demonstrated experience in designing and 
• delivering training courses for audience not specialized in public health; 
• Excellent analytical, written and verbal communication skills in English are required; 
• Excellent interpersonal skills 

Expressions of interest must be received no later than 16:00 o'clock on Monday 19 May 2014. 
Please include copies of your CV as well as a description of the kinds of issues you would 
consider as part of this work (i.e. what framing you would take to address health in EIA). The 
expressions of interest are to be delivered electronically to Ms Sophie Schmitt at the following 
email address: schmitts@who.int.

[Via Michaela Pfeiffer, WHO]

Urban HEART Report

The WHO Centre for Health Development has published a report on the Expert Consultation on Urban HEART held in November 2013. It's a worthwhile read for anyone with an interest in HIA, health equity and urban planning issues at the city level.

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.

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.

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.

WHO Determinants of Health Discussion Paper Series

This is a WHO publication series devoted to the social determinants of health.

The series explores themes related to strategy, governance, tools and capacity building for addressing the social determinants of health to improve health equity

Action on the Social Determinants of Health: learning from previous experiences
Download discussion paper 1 at: http://bit.ly/14eLnIb

A Conceptual Framework for Action on the Social Determinants of Health
Download discussion paper 2 at: http://bit.ly/ZiWe5j

Monitoring Social Well-being to Support Policies on the Social Determinants of Health:
the case of New Zealand's "Social Reports/Te Purongo Oranga Tangata"
Download discussion paper 3 at: http://bit.ly/12m6FsX

Public Health Agencies and Cash Transfer Programmes:
making the case for greater involvement
Download discussion paper 4 at: http://bit.ly/11AeIe4


Evaluating intersectoral process for action on the social determinants of health:
Learning from key informants
Download discussion paper 5 at: http://bit.ly/10MLZY7

Addressing social determinants of health through intersectoral actions:
Five public policy cases from Mexico
Download discussion paper 6 at: http://bit.ly/15DrU77

Economic arguments for intersectoral interventions that improve the social determinants of health: Mexico
Download discussion paper 7 at: http://bit.ly/18QJus8

Cross-country analysis of the institutionalization of Health Impact Assessment
Download discussion paper 8 at: http://bit.ly/11V2G4Y

The Role of the World Health Organization in the International System

• Since the World Health Organization (WHO) was founded in 1948, the development of many new institutions in the field challenges its original vision as the 'directing and coordinating body on international health work'.
• WHO evolved from a body principally aimed at the control of infectious diseases to a more holistic approach to the improvement of health characterized in the 1970s by the slogan 'Health for All'.
• The entry of the World Bank as a major health funder in the 1980s and a proponent of market-based health policies challenged WHO's pre-eminent position in the field.
• Under Director-General Dr Gro Harlem Brundtland in the 1990s a serious attempt was made to refocus WHO and raise its status as a player in the development policy arena, but with mixed success and limited sustainability.
• More recently WHO's chronic financial problems, characterized by excessive dependence on voluntary short-term funding by donors, have precipitated another round of reform.
• The question is whether WHO member states and its secretariat are asking sufficiently searching questions about WHO's place in the international system and what might need to be done to put its future on a more secure footing.    

This is the first paper in a series related to the Chatham House Centre on Global Health Security which are aimed at improving global health security.

The series consists of papers prepared for the Centre’s Working Groups on Governance and Financing, which are aimed at improving global health security through examining the way global and national institutions related to health are governed and financed. 

The publication is now available at the following link and the summary points can also be found below: http://www.chathamhouse.org/publications/papers/view/189351

Free Online Training! WHO/Europe Health Economic Assessment Tool (HEAT) for walking and cycling

WHO/Europe’s Health Economic Assessment Tool (HEAT) for walking and cycling is an online resource to estimate the economic savings resulting from reductions in mortality as a consequence of regular cycling and/or walking (see www.heatwalkingcycling.org). HEAT can be used by walking and cycling campaigners, researchers and policymakers alike. It enables users to estimate the value to health of new infrastructure, policies or programmes. These can be used to make the case for new investment, or as inputs to comprehensive health impact assessments.

To help people in the use of this tool, WHO/Europe is now offering online training sessions on the following dates:
•         30 November 2012
•         14 December 2012
•         14 January 2013
•         22 February 2013
•         15 March 2013

All sessions will start at 15:00 Central European Time, and will last approximately one hour. During this time you will be walked through an example of HEAT, and be able to ask questions online to experts on HEAT.

Please register by sending an e-mail to training@heatwalkingcycling.org stating:
•         The date of the session you wish to join
•         Any details of ways that you have used the HEAT
•         Any specific questions you would like addressed during the training

We will then send you details of how to log on and access the training session in due time.

Please feel free to forward this message to other colleagues or mailing lists of possibly interested HEAT users.

Kind regards,
Christian Schweizer
Technical Officer, Transport and Health
Division of Communicable Diseases, Health Security and Environment
World Health Organization - Regional Office for Europe

Impact Assessment as a tool for Multisectoral Action for Health

The WHO Centre for Health Development recently convened a consultation on impact assessment as a tool for multisectoral action for health. The summary report is worth reading and will inform a number of upcoming conferences and events.

HIA in Latvia

Interesting report on Strengthening the implementation of health impact assessment in Latvia from WHO Europe. Worth a read.

Health baseline information in impact assessment

The paucity of reliable health baseline information to carry out HIA in developing countries context has always been a key issue within the HIA discussion. There are arguments in favor of collecting and generating new data, but there are also arguments against this approach. The arguments against mainly center around: costs of data collection and ethical issues about invasive data collection mechanisms. The arguments in favor point to the lack of dependable data needed not only to assess the impacts, but also to monitor the recommendations measures and for the early identification of intended impacts.

Malaria offers a very goo example of the difficulties and challenges of using already existing data to estimate burden of disease in a given context.

The Institute for Health Metrics and Evaluation published an article on the Lancet last Friday suggesting that 1.24 million people died from the mosquito-borne disease in 2010. This is twice what estimated by WHO and partners for the same year. The research used new data and new computer modeling to build a historical database for malaria between 1980 and 2010. WHO has just issued a communication welcoming the research and the effort, but basically WHO re-confirms the precedent estimate of 655 000 deaths attributable to malaria.

While everybody agrees that the burden is extremely high for both estimates, the difference between the 2 numbers is anyway of concern. The research involved trying to judge the impact of the misclassification of deaths in the affected regions. This readjustment alone generated a rise of 21% in the number of malaria deaths. Beside the effects that the mathematical model chosen has on the final data, the issue of the quality of initial data is essential. In the majority of settings where malaria is a feared killer, diagnosis is done clinically without any form of diagnostic devise. Fever is a symptom of malaria, but it is not necessarily malaria. In such settings the collection of baseline information on the health status and determinants of the population residing in the project foot print is therefore very important and the gathering methods should be designed to satisfy project information requirement and ethical aspects.

This discussion is an ongoing one within the HIA community and for those interested there is a session “Health baseline data within different impact assessments” at the next IAIA conference.

What is a Child Friendly City?

It is a city, or more generally a system of local governance, committed to fulfilling children's rights, including their right to:

• Influence decisions about their city
• Express their opinion on the city they want
• Participate in family, community and social life
• Receive basic services such as health care and education
• Drink safe water and have access to proper sanitation
• Be protected from exploitation, violence and abuse
• Walk safely in the streets on their own
• Meet friends and play
• Have green spaces for plants and animals
• Live in an unpolluted environment
• Participate in cultural and social events
• Be an equal citizen of their city with access to every service, regardless of ethnic origin, religion, income, gender or disability

A child friendly city is the embodiment of the Convention on the Rights of the Child at the local level, which in practice means that children’s rights are reflected in policies, laws, programmes and budgets. In a child friendly city, children are active agents; their voices and opinions are taken into consideration and influence decision making processes.

Check out the website by clicking here.

Check out the community assessment tools here.

Rio Political Declaration on Social Determinants of Health

The bits that really resonated with me are:

We reaffirm that health inequities within and between countries are politically, socially and economically unacceptable, as well as unfair and largely avoidable, and that the promotion of health equity is essential to sustainable development and to a better quality of life and well-being for all, which in turn can contribute to peace and security.

We reiterate our determination to take action on social determinants of health as collectively agreed ... three overarching recommendations of the Commission on Social Determinants of Health:

• to improve daily living conditions;
• to tackle the inequitable distribution of power, money and resources; and
• to measure and understand the problem and assess the impact of action.

We are convinced that action on these determinants, both for vulnerable groups and the entire population, is essential to create inclusive, equitable, economically productive and healthy societies. Positioning human health and well-being as one of the key features of what constitutes a successful, inclusive and fair society in the 21st century is consistent with our commitment to human rights at national and international levels.

Click here to go to the WHO conference website and download the Declaration.