Would you do health impact assessments if you didn't have to?

Carrot and Stick by Bruce Thomson

There's an interesting article by Elsa João and Anna McLauchlan in the latest issue of Impact Assessment and Project Appraisal. They asked 187 Scottish Strategic Environmental Impact Assessment (SEA) practitioners "if SEA was not compulsory, would you do it?"

This made me wonder about this question in relation to HIA. In many, if not most settings, there is not a requirement that makes HIA's use compulsory. For most HIA practitioners this question is not a hypothetical one. We encounter it in relation to every HIA.

Some recent  research I was involved in found that only 7% of HIAs conducted in Australia and New Zealand between 2005 and 2009 were done to meet a legal or regulatory requirement.

The overwhelming majority of Scottish survey respondents said they would do SEA even if it was not compulsory. In HIA practice we rarely have to wonder, which is a luxury in some ways. Most HIAs are done freely and to learn something. The link between voluntary involvement and the ability to learn something from HIAs is not theoretical. As my colleagues and I found in this study, the extent to which participants had a degree of choice or control over their involvement in an HIA had an impact on their receptiveness to learning from the HIA process and acting on its recommendations.

Interestingly, even though the survey was looking at SEA in Scotland where its use is mandated, the themes identified through the survey resonate with those we encounter in promoting HIA's use:

• the perception that a similar process are already being done;
• a lack of resources;
• the need for a ‘leaner process’; and
• the difficulties that can arise when external conditions or many decisions have already been determined.

The article is well worth reading, here's the abstract:

Strategic environmental assessment (SEA) is undertaken in more than 60 countries worldwide. Support to the SEA process can range from formal legal requirements to voluntary ‘ad hoc’ approaches. In the cases where SEA is legally required, such as in Europe where the SEA Directive sets a framework for SEA legislation in 28 countries, practitioners may engage with SEA but in a reluctant way. This paper reports on a unique survey of 203 key people responsible for implementing the SEA legislative requirement in Scotland. The majority (53%) of the 187 practitioners who answered the hypothetical question ‘If SEA was not compulsory, would you do it?’ said ‘Yes’. However, results suggest that the responses were much nuanced. Practitioners were asked to explicate their reasoning and, irrespective of whether the answer was ‘yes’ or ‘no’, common themes were evident in accompanying remarks. This paper enables reflection on reasons for acceptance or rejection of the SEA process by discussing: the perception that a similar process to SEA is already being done, the problem with lack of resources, the call for a ‘leaner process’ and the difficulties of undertaking SEA when conditions are already determined at a higher ‘tier’.

http://www.ingentaconnect.com/content/tandf/iapa/2014/00000032/00000002/art00001

The effectiveness of HIAs conducted in Australia and New Zealand

It occurred to me that I haven't posted a link to the final report on the Australian Research Council-funded study on the effectiveness of HIAs conducted in Australia and New Zealand between 2005 and 2009. The report has lots of information in it. Download it here.

Michiko Hoshiko: Researching the use of health impact assessment in Japan and Australia

I have been conducting research related to health impact assessment in Japan since 2008 at the Kurume University School of Medicine. As part of this I have been involved in several HIAs, for example our health impact assessment of the transition to a “core city” (core cities are cities of more than 300,000 people that take on greater governmental autonomy and some of the responsibilities of prefectural governments) and a HIA of the redevelopment of a major hospital site. I have also been involved in the development of a HIA screening checklist for use in government.

Following the completion of my PhD I have been able to pursue further research into HIA, through a fellowship based at the University of New South Wales in Sydney, Australia. My aims during the fellowship are:

1) Investigate the use of HIA screening checklists I will investigate the use made of the NSW Healthy Urban Development Checklist as a tool for engaging with local government officials around population health issues, comparing it with the checklist I developed at Kurume University in Japan.

2) Investigate the use of health impact assessment in local government I will investigate the use of health impact assessment and related tools to improve the population health impacts of decisions made by local government. In particular I will investigate process and procedural aspects of HIA that are associated with impacts on local government decision-making and implementation.

3) Investigate the use of health impact assessment in urban regeneration projects and major projects I will investigate the role of HIA in influencing the health impacts of urban regeneration projects, and its role in addressing health within major project assessment.

4) Investigate and compare the different barriers and facilitators for HIA’s use in Japan and Australia During my staying in Australia, I will conduct research on the different barriers and facilitators for HIA’s use, particularly on issues such as health service planning, urban sprawl, energy, and disaster response.

I hope to develop at least two academic journal articles on this program of research. If you’d like to find out more about my research or get in touch please email me at hmichi AT med.kurume-u.ac.jp

Ghana Health Service recruits HIA and other health experts for a consultancy

The Ghana Health Service will conduct a strategic Health Impact Assessment (sHIA) of the country’s oil and gas development plan. The objectives of the sHIA are to:

• Generate a comprehensive review of human risks associated with different development scenarios for oil and gas sector, for example in the context of chemical spills, changes in communicable disease patterns, workplace based accidents and injuries etc.;

• Identify which interventions and response capacities would be needed to address those issues, including so as to not overwhelm existing health systems capacities;

• Establish a population health baseline, framework for use in monitoring and reporting of health impacts (both positive and negative) generated as a result of the growth of the petroleum industry;

• Develop Ghana’s institutional capacity for the use of HIA tools and methods for the eventual application to other sector policies, plans and projects, for example in mining, energy or agriculture.

The Ghana Health Service now invites eligible Consultants (Health Impact Assessment Specialists, Occupational Health and Safety Specialists and Chemical Safety Specialists) to indicate their interest in providing the services. Interested Consultants should provide information indicating they are qualified to perform the services (brochures, description of similar assignments, experience in similar conditions, availability of appropriate skills among staff, curriculum vitae etc) Consultants may associate to enhance their qualifications.

A consultant will be selected in accordance with the procedures set out in the Public Procurement Act, 2003 (Act 663) of the Republic of Ghana.

Interested consultants may obtain further information at the address below from 08.00hrs to 17.00 hrs GMT.

Expressions of interest must be delivered to the address below on or before 14.00 hrs GMT, on September 03, 2012              

THE PROCUREMENT DEPARTMENT

GHANA HEALTH SERVICE

LIMB FITTING CENTRE, TEMA STATION

NEAR RENT CONTROL

P.M.B. MINISTRIES

Tel:  (233) 0302 687853

Fax:  (233) 0302 687853 (for queries only)

E-mail: procurement@ghsmail.org

Stress Mapping and other visual tools to improve bicycling network

Mineta Transportation Institute at San Jose conducted a study on bicycling network to identify the key factors to improve bike commuting by so-called “level two” cyclists: those who will ride if car traffic is minimal.

The main determinant of biking is a low-stress, well-connected and relatively direct route.  This research has highlighted the importance of intersection approaches and street crossings in network connectivity. A major achievement has been developing criteria for crossing stress and a way of integrating intersection stress with the stress on a link.

The researcher proposes a set of criteria by which road segments can be classified into four levels of traffic stress (LTS). LTS 1 is suitable for children; LTS 2, based on Dutch bikeway design criteria, represents the traffic stress that most adults will tolerate; LTS 3 and 4 represent greater levels of stress.

The study then mapped every street in San Jose according to LTS and they found that only about five percent of shorter (under six miles) work trips in San Jose could currently be accomplished on low-stress (levels one and two) streets, but this figure would almost triple if improvements in strategically placed segments that provide low-stress connectivity across barriers were implemented. 

Public Event in Sydney: Effectiveness of HIA in Australia & New Zealand

The findings of a two year Australian Research Council-funded study into the effectiveness of HIA will be discussed at a one day validation meeting at the University of New South Wales on 15th June from 9am-4.30pm.

Download flyer

Cost

$20.00 (at the door includes lunch), Concession holders and NGOs free

RSVP: Mary Knopp 02 96120779 mary.knopp@sswahs.nsw.gov.au (numbers are limited)

Opening Address

Andrew L. Dannenberg, MD, MPH, is an Affiliate Professor of environmental health and of urban design and planning at the University of Washington in Seattle.  He also serves as a consultant to and was formerly Team Lead of the Healthy Community Design Initiative in the National Center for Environmental Health at the U.S. Centers for Disease Control and Prevention in Atlanta.  For the past decade, his research and teaching has examined the health aspects of community design including land use, transportation, urban planning, and other issues related to the built environment.  He has a particular focus on the use of a health impact assessment as a tool to inform community planners about the health consequences of their decisions.  Dr. Dannenberg is co-author with Howard Frumkin and Richard Jackson of Making Healthy Places: Designing and Building for Health, Wellness, and Sustainability published by Island Press in 2011.

Program

• Welcome. Professor Mark Harris
• Opening: Professor Fan Baum – what did WHO CSDOH say about HIA as a tool for addressing health inequity
• HIA in the USA: What can we learn from each other ? Dr Andy Dannenberg
• HIA in NZ: Prof Louise Signal & Prof Richard Morgan
• HIA in Australia Prof Jeff Spickett & Patrick Harris
• Research Findings
• Q& A on research findings
• Case Studies:
• Far North Queensland
• SW Sydney
• Hawkes Bay, NZ
• Panel: Implications for policy and practice

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.

Priorities for Research on Equity and Health: Towards an Equity-Focused Health Research Agenda

Really interesting paper and as it's open access I've highlighted the thing bit that caught my eye rather than the summary points (abstract).

Some of it seems really hard to me! The whole paper is worth a read.

Characteristics of Third Wave Health Research Strategies and Methodologies

1. Go beyond the behavioral and other individual determinants of illness.
2. Examine the intersections among different social hierarchies, such as class and gender, and their cumulative impacts on health status and health inequities.
3. Examine the levels, pathways, and power connections across the “upstream” determinants or root causes of health inequities—that were central to the CSDH's conceptual framework—and the more traditionally investigated determinants of health inequities, such as risk factors or access to care.
4. Treat patterns of health inequity as a social reality in their own terms, requiring social (economic, sociological, political, and cultural) explanation that adds on to the aggregation and interpretation of individual biomedical processes and outcomes.
5. Consider the dynamic (rather than static) nature of equity in different country contexts, introducing a temporal dimension when investigating social structures, public policies, and impacts over the life course.
6. Describe the social institutions and processes that influence the generation and allocation of resources related to health and its social determinants.
7. Focus on how the global context affects choices about resource allocation at national and sub-national levels.
8. Build on active collaboration among researchers and other knowledge producers from different disciplines.
9. Recognize that certain kinds of evidence, such as results from randomized controlled trials, cannot be generated with respect to many interventions that address social determinants of health; therefore, a need exists to embrace diverse methodologies—fit for purpose—including a wide range of study designs, generating qualitative and quantitative data, that provide critical insight on the questions being examined.
10. Involve affected populations, which is often essential to appropriate research designs and their execution.

Source:

Priorities for Research on Equity and Health: Towards an Equity-Focused Health Research Agenda.

Östlin P, Schrecker T, Sadana R, Bonnefoy J, Gilson L, et al. (2011)

PLoS Med 8(11): e1001115. doi:10.1371/journal.pmed.1001115

Click here to go to the full article.

Hat tip: David McDaid, Health Equity Email Network, UK