HIA2007 South East Asia and Oceania HIA Conference Update

Abstracts Received
We have received a strong response to the call for abstracts, with submissions received from Australia, New Zealand, Thailand, Laos, Vietnam, Japan, Korea, India, Canada, Nepal and the United Kingdom. Abstracts will be reviewed by the scientific committee in coming weeks and the program will be posted online soon

Online Registration Now Open!
Online registration has opened and can be accessed at http://www.hia2007.com/registration.htm

Early bird registration closes 24 September.

Conference Opening
The conference will be opened by The Hon. Verity Firth, a Minister in the New South Wales Government. Her appointments include:

• Minister for Science and Medical Research
• Minister for Women
• Minister Assisting the Minister for Climate Change, Environment and Water (Environment)
• Minister Assisting the Minister for Health (Cancer)

The Minister is also a Councillor for the City of Sydney.

AusAID Funding
We have been successful in securing funding under AusAID's International Seminar Support Scheme for a group of delegates from Vietnam, Laos and Cambodia to attend the conference. We hope this will further strengthen the conference's regional outlook.

For more on the conference got to www.hia2007.com

HIA Community Wiki gets a facelift!

The HIA Community Wiki has just had a redesign. There's been a lot of little tidying up but the four main changes are:

• The International HIA Blog gets pride of place on the front page through a swish new free widget from Springwidget.
• There's a new free Flickr photo badge that refreshes every time you visit the site.
• Check out the HIAwiki's visitor and hit rate through the 'Visitors to the site' page on he main menu bar at the top.
• There also a new calendar list on the Conferences/events page.
  

HIA eNews Issue 18 Avaiable

Issue 18 of the NSW Health Impact Assessment Project eNews is now available. This issue looks at:

• Ways Forward for HIA in Local Government: Considering health and wellbeing at the local level
• What’s the Future of the HIA Gateway?
• New Thai National Health Act: Participatory HIA enshrined in law
• Planning and Health: Findings from the UK Royal Commission on Environmental Pollution

Download [PDF 520Kb]

New HIA Listserv: Asia Pacific Health Impact Assessment Email List

A meeting of HIA practitioners from across the Asia Pacific region was held during the recent International Association for Impact Assessment conference in Seoul. It was decided during the meeting that there was a need for an email discussion list to facilitate information exchange across the region.

I have established an Asia Pacific HIA Email List. The list currently has over 120 subscribers from 18 countries. If you would like to join the list please send an email to majordomo@explode.unsw.edu.au with "subscribe hia-seao" as the body of the email (further details below).

Members
This email list is intended for practitioners and those with an interest in health impact assessment from across the Asia Pacific region.

Purpose
To provide an mechanisms for information exchange and networking across the Asia Pacific region.

To subscribe
Send an email to majordomo@explode.unsw.edu.au with "subscribe hia-seao"as the body of the email.

To unsubscribe
Send an email to majordomo@explode.unsw.edu.au with "unsubscribe hia-seao"as the body of the email.

To send an email to the list
Send your email to hia-seao@explode.unsw.edu.au
Attachments up to 1 Mb are permitted, though not encouraged. Links to files hosted on the web are preferred.

Deadline Extended: Abstracts for HIA2007 South East Asia and Oceania Health Impact Assessment Conference

The deadline for submission of abstracts for the HIA2007 South East Asia and Oceania Health Impact Assessment Conference has been extended until Monday 2 July 2007. Abstracts can be submitted online at www.hia2007.com and are invited under the following themes:

• Health Impact Assessment in Practice
• Health, Community Wellbeing and Sustainability
• Creating Environments for Health
• Liveable Urban Communities
• Working with Other Sectors

The conference is being held in Sydney, Australia from 7-9 November 2007. Further information is available from http://www.hia2007.com

South East Asian Regional Training Course on HIA

By Suphakij Nuntavorakarn and Nuntana Sabrum, Thai Healthy Public Policy Foundation

The Thai Health Systems Research Institute recently held an “HIA Interactive Training Course: A Learning Tool for Healthy Community and Society” in Khon Kaen province of Thailand.

The five-day training course was carried out during 15th to 19th October 2006 through a diversity of processes such as lectures, group work, open discussion and field visits in order to strengthen essential HIA skills and knowledge and to create framework for collaborative research and networking within Southeast Asia and Oceania.

Twelve regional and nineteen local health experts and practitioners attended the event. The regional participants were from Lao PDR, Vietnam, Cambodia, Malaysia, and Australia. Suggestions and ideas shared during the training have led to further HIA development in the region including the development of HIA training manual for developing countries, expert exchange and technical visits. One of the concrete outcomes is that more HIA work has been produced by the new faces from Mekong River Basin and will be presented in the upcoming international events such as the IAIA07 conference in South Korea and HIA2007 conference in Australia.

The training and subsequent activities are part of the “HIA Development for Developing Countries Project” supported by Thai-Health Global Linkage Initiative Program (T-GLIP), which is funded through the Thai Health Promotion Foundation. The need for the project arose from an increasing awareness of trans-boundary health impacts and the need to prevent and manage them through regional collaboration.

Copies of the training manual developed by the Healthy Public Policy Foundation are now available. Forfm more information contact Wipawa Chuenchit.

Planning and Health: Findings from the UK Royal Commission on Environmental Pollution

by Andrew Buroni, RPS Group

The UK Royal Commission on Environmental Pollution (RCEP) is an independent body established to advise the Queen, the Government, Parliament and the public on environmental issues.

The Commission's advice is mainly in the form of reports, of which their most recent is on the Urban Environment. In this report the RCEP acknowledges current shortcomings in the planning system and recommends that the UK government and devolved administrations develop a statutory framework for including Health Impact Assessments in the planning process.

This article provides a summary of the RCEP report, detailing the recommendations to Government and future HIA planning requirements.

Planning and Health
The planning system offers an important opportunity for a more coherent effort to develop cities and improve the health and wellbeing of urban inhabitants.
Evidence suggests that planning can not only be applied to tackle and offset many of the adverse health effects of an urban environment, but can also be applied to address and prevent many of today’s significant physical, mental and social health issues.

The mode of health effect is complex and represents a mixture of physical influences such as the removal of environmental risks, social influences brought about through improved connectivity and support through to behavioral responses from improved perceptions of the environment.

Potential outcomes from more health conscientious planning therefore reflect real opportunities to contribute in reducing cardiovascular and respiratory ailments, obesity, diabetes, road traffic accidents, antisocial behavior and crime and foster improved self-rated health, wellbeing and ultimately healthier communities.
The ethical and financial benefits of preventative health measures over treatment are key to Government policy represented through the White Paper, ‘Saving Lives: Our Healthier Nation’ and supported by the Department of Health, the National Institute of Clinical Excellence and regional Health Authorities.

However, to date, consideration of health and wellbeing has had little influence in urban design and planning and the present planning system is still unable to adequately deal with complex public health issues.

Planning applications for large-scale developments often require an Environmental Impact Assessment (EIA). These assessments can include data on environmental problems like air pollution that can cause health effects, but while they may predict environmental emissions from future developments to compare with relevant standards, they do not always look at health impacts in terms of a population’s vulnerability and exposure to health risks.

EIAs and planning applications therefore tend to not consider health and wellbeing issues in a systematic manner do not recognise the complex interrelations between social and environmental factors and rarely identify measures to enhance health benefits.

Recognition of the planning systems failure to adequately address health is not new. The RCEP’s previous report on Environmental Planning, highlighted the general issues and recommended the Government integrate processes such as Health Impact Assessment (HIA) within EIA back in 2002.

In its response, the government recognised the benefits of HIA, but stated that it was “not persuaded that detailed Health Impact Assessments, which require different expertise and methodologies, should form an integral part of Environmental Impact Assessment at individual project level”.

However, during the most recent RCEP study, the Department of Health supported the inclusion of HIA within the EIA process as the best means of considering health issues in the planning process, and the RCEP strongly concur.
The RCEP therefore reinforces its recommendation that Health Impact Assessments be incorporated explicitly in Sustainability Appraisals, Strategic Environmental Assessments and Environmental Impact Assessments.

In order to implement this, the RCEP further recommend that the UK government and devolved administrations develop a statutory framework for including Health Impact Assessments in the planning process.

Future HIA Requirement in the Planning Process
The RCEP’s study reinforces the consensus view of UK health organisations and Local Government in that a formal requirement to assess the potential health effects of development is long overdue.

In the absence of leadership from Government and a lack of a formal requirement to conduct HIA, Local and Regional Government are developing their own initiatives to ensure that health is addressed in the planning process.

• In London, the Greater London Authority Act (1999) places a duty on the Greater London Authority (GLA) to promote the health of Londoners and to take into account the effect of its policies on health and inequality. Supporting the GLA Act, the Mayor appointed the London Health Commission to drive health improvement in priority areas across London, to investigate specific health issues if it wishes and to drive the practice of HIA across London. Complementing the GLA Act, the Mayor of London has recently released Best Practice Guidance setting out how health inequalities can be tackled through more informed planning, policies and proposals subject to HIA.
  The Welsh Assembly have recently published a Draft Interim Planning Policy Statement on Planning, Health and Well-being, forming the first planning requirement for HIA in the UK.
• The Department of Health and the Health Protection Agency are developing guidance to advise health authorities on how to integrate health into Strategic Environmental Assessment (SEA).
• Primary Care Trusts and Strategic Health Authorities are becoming more involved in the planning process and specifically requesting HIA.
• Developers are voluntarily commissioning HIA to identify potential health risks, to facilitate health improvements and avoid often-costly remediation.

In light of the growing demand and clear benefits of HIA, the RCEP recommendation is likely to be the precursor for the development of the first UK statutory requirement to conduct HIA.

Any further delay by Government may be perceived as a deliberate attempt to avoid tackling the often-emotive topic of health.

New Thai National Health Act: Participatory HIA Enshrined in Law

The Thai National Health Act B.E. 2550 (2007) was recently approved and entered into force on 19th of March. The ambitious legislation includes several sections on HIA, which cover the rights of Thai people to demand a HIA be conducted and to participate in HIA process, as well requiring the development of guidelines and procedures for HIA to be developed by the newly established National Health Committee.

According to the Act, HIA is designed to be a “social learning process”, which has been developed so that all stakeholders in society can be involved in examining the health impacts of policies, projects or activities that have already affected or may affect groups of people. This social learning process involves identifying and supporting the most appropriate alternative in public decision-making processes with the goal of protecting and promoting the health of all people in Thai society.
For more information on the Act email suphakijn@yahoo.com

This post was written by Suphakij Nuntavorakarn from the Thai Healthy Public Policy Foundation and originally appeared in the International Association for Impact Assessment's HIA Quarterly.

Speakers Announced for HIA2007 Conference

The speakers for the HIA2007 South East Asia and Oceania Health Impact Assessment Conference have been announced. The eleven keynote speakers are leaders in their fields and have a diverse array of expertise, ranging from sustainability to healthy urban environments to healthy equity and HIA practice.

To find out more about the HIA2007 South East Asia and Ocean HIA Conference go to http://www.hia2007.com

Confirmed speakers include:

Hugh Barton
WHO Collaborating Centre for Healthy Cities and Urban Policy, University of West England, Bristol

Professor Hugh Barton has conducted extensive research on sustainability, planning and the health impacts of urban environments.

Robert Bos
Sanitation and Health, World Health Organization, Geneva

Robert Bos has an extensive history of developing methods and capacity to use HIA on water resource developments as part of the WHO’s Water, Sanitation and Health Program.

Andrew Gilman
Sustainable Solutions International, Ottawa

Dr Andrew Gilman has had an extensive career working on sustainability and health issues in Canada and internationally. He is the former Director of Health Canada’s Office of Sustainable Development.

Ashley Gould
Welsh Local Government Association, Cardiff

Ashley Gould has worked on a number of health improvement initiatives at the local government level in Wales, including HIA. His current work focuses on capacity building and partnership working for health and wellbeing.

Elizabeth Harris
Research Centre for Primary Health Care and Equity, University of New South Wales, Sydney

Elizabeth Harris’ research led to the development of the Equity Focused Health Impact Assessment Framework. Her work has focused on the development and implementation of policy and practice interventions to reduce health inequalities.

Richard Morgan
Centre for Impact Assessment Research and Training, University of Otago, Dunedin

Professor Richard Morgan has extensive experience in environmental management and HIA. He was president of the International Association for Impact Assessment in 2004.

Rob Quigley
Quigley and Watts Associates, Wellington

Rob Quigley has played a key role in the development of HIA in England and New Zealand. He is actively involved in a range of HIAs across New Zealand.

Wiput Phoolcharoen
Thai Healthy Policy Foundation, Bangkok

Dr Wiput Phoolcharoen has wide-ranging expertise in public health issues in the South East Asian Region. He is the former Director of the Thai Health Systems Research Institute and currently the President of the Thai Healthy Public Policy Foundation

Decharut Sukkumnoed
Thai Healthy Policy Foundation and Kasetsart University, Bangkok

Dr Decharut Sukkumnoed has guided the development of HIA and healthy public policy in Thailand over the past seven years. His work on the health impacts of energy policy has influenced

Daniel Tarantola
Initiative on Health and Human Rights, University of New South Wales, Sydney

Professor Daniel Tarantola has had a distinguished career as an advisor World Health Organization and was involved in the creation of Médecins Sans Frontières. He is best known for his influential work in the area of HIV/AIDS and human rights.

Gareth Williams
Cardiff Institute of Society, Health and Ethics, Cardiff University, Cardiff

Professor Gareth Williams has over 20 years of experience in the sociology of health and wellbeing. His current research looks at the relationships between economic regeneration, community development and sustainable health.

The reflective HIA practitioner

“In a practitioner’s reflective conversation with a situation [an initiative]…she functions as agent/experient.
Through her transaction with the situation, she shapes it and makes herself part of it.”
The Reflective Practitioner by Donald Schön

Journal Watch: New HIA publications and reports

Bhatia R. Protecting Health Using an Environmental Impact Assessment: A case study of San Francisco land use decisionmaking, American Journal of Public Health, 97(3):406-413, 2007.
http://dx.doi.org/10.2105/AJPH.2005.073817

CST. Health Impacts: A strategy across governments (Submission Paper), Council for Science and Technology: London, 2006.
http://www2.cst.gov.uk/cst/reports/files/personal-information/csthealthimpacts.pdf

Jay S et al. Environmental impact assessment: Retrospect and prospect, Environmental Impact Assesment Review, Corrected Proof in Press, 2007.
http://dx.doi.org/10.1016/j.eiar.2006.12.001

Lee K et al. Bridging health and foreign policy: the role of health impact assessments, Bulletin of the World Health Organization, 85(3):207-211, 2007.
http://www.who.int/entity/bulletin/volumes/85/3/06-037077.pdf

Lomas J. The In-Between World of Knowledge Brokering, British Medical Journal, 334:129-132, 2007.
http://www.bmj.com/cgi/reprint/334/7585/129

Mannheimer L et al. Introducing Health Impact Assessment: An analysis of political and administrative intersectoral working methods, The European Journal of Public Health, Corrected Proof in Press, 2007
http://dx.doi.org/10.1093/eurpub/ckl267

OGP & IPIECA. A Guide to Health Impact Assessments in the Oil and Gas Industry, International Petroleum Industry Environmental Conservation Association & International Association of Oil & Gas Producers: London, 2005.
http://www.ipieca.org/downloads/health/hia/HIA.pdf

Scott-Samuel A, O’Keefe E. Health impact assessment, human rights and global public policy: a critical appraisal, Bulletin of the World Health Organization, 85(3):212-217, 2007.
http://www.who.int/entity/bulletin/volumes/85/3/06-037069.pdf

Smith B et al. WHO Health Promotion Glossary: New terms, Health Promotion International, 21(4):340-345, 2006.
http://dx.doi.org/10.1093/heapro/dal033

Developers and Businesses: HIA's forgotten stakeholders

I work with developers and businesses every day and there are times when it can be frustrating to get them to understand why they need to consider health and wellbeing issues beyond occupational health and safety. But often they do engage and do listen though they don't immediately jump to doing HIAs they are thoughtful enough to ask pertinent questions.

One of the most striking things about international policy and practice around project-level HIAs is the complete absence of discussion and debate about how we engage with developers and businesses. For me, they are 'HIA's forgotten stakeholders' or perhaps they are the proverbial 'elephant in the room' everyone knows they're there but doesn't want to look at them or discuss their presence.

Developers are seen as being, and sometimes can be, obstructive and hostile to HIA and its ethos. But often the fault lies as much with us in the public health and HIA community as with developers and businesses. We espouse values of openness and transparency but that seems to extend only to communities, NGOs and public institutions. We see developers as antagonists rather than fellow protagonists in the HIA drama. Society's 'villains' rather than its 'heroes'.

Often we don't even see them as stakeholders, let alone important stakeholders, in the HIA process. And in some cases, apart from wanting to access their environmental and health information, they are actively excluded from the process.

Quite rightly, there are concerns that developers, and businesses in general, have considerable financial power and political influence but we in the HIA community should not be afraid to engage, discuss and debate with them.

We need to be more active in educating, persuading and lobbying these key stakeholders about HIA, it value and how they can become enthusiastic and co-operative partners in the HIA process. Okay, so some of you are going to say 'Enthusiastic partners, never gonna happen!'. Maybe so, but with corporate social responsibility, ethical funds and sustainable actions growing in prominence developers and businesses are beginning to understand that need to grapple with the health and wellbeing implications of their plans and projects.

The lack of an active engagement programme, anywhere in the world, that reaches out to and engages with this group is startling and a critical weakness of current HIA policy and practice. Why so? Because ultimately it is businesses and local communities who tend to foot the bill for HIAs either directly or through taxes.

Having a proactive engagement process with developers and businesses has more pros than cons if we are strong in our values. It is only by proactively engaging with them and winning them over that we can transform their vision of the world and the free market to include health and wellbeing - alongside sustainability and the environment - as a critical factor in enhancing their business success.

Lastly, if Greenpeace and Friends of the Earth can do it why shouldn't and why can't we?

Post-Normal Science, Community Knowledge and HIA

Post-normal science is a philosophical framework which argues that when normal science cannot predict future consequences with any degree of certainty and decisions with a strong social and political dimension need to be made, i.e. when facts are uncertain and decisions urgent, then using an extended peer community of affected stakeholders to review and ‘quality assure’ the facts and help develop a consensus way forward leads to more accurate and robust scientific decision-making.

Post normal science argues that 'normal' science works best when the uncertainty is limited and the importance of the decision is low. In such contexts the 'technical' uncertainty is reduced by using statistics. When uncertainty is greater and the decision stakes higher then professional judgement and consensus are used to reduce the uncertainty (alongside statistics). However, in contexts with high uncertainty and high decision stakes statistics and professional consensus are not enough. In these situations creating a larger peer review community made up of both professionals and lay people is also needed to 'quality assure' and enhance the accuracy and robustness of the predictions, judgements and decisions made.

What are the implications of this for HIA practice?

HIA involves the prediction of health and wellbeing impacts of a diverse group of individuals and communities, via compex pathways and over long periods of time. This high uncertainty is often married to high stakes local and regional or national decision-making e.g. the siting of waste and major other facilities.

The primary goal of community engagement in HIA is therefore less about consulting, involving or empowering (though these are important objectives in themselves) and more about uncovering the localised experiential knowledge base that communities have about both the existing negative impacts in their neighbourhoods and the potential impacts that might emerge if a proposed plan, programme or project is implemented.

Communities have valuable experiential knowledge about how their comunities work and how projects and plans have fared in the past that is crucial to gaining a holistic understanding of the potential health and wellbeing impacts. However, it is not enough or scientifcally acceptable just to ask communities about what they would like and what they think the positive and negative health impacts might be of a plan or project; but also - and more importantly - why they think so and what evidence they have that what they say is likely to happen.

HIA practitioners need to weigh up and evaluate this community evidence and assess its worth just as they would do with any other form of evidence. Who is saying what and why, how long have they lived in the area, do they cite examples and provide evidence that can be verified through other sources, how much agreement and disagreement is their between individual members of a community and on what issues.

Community evidence can therefore be critically reviewed in much the same way that other scientific evidence is reviewed and evidence review structures need to be developed to accommodate this kind of evidence. Post-normal science provides the foundations for developing such structures and processes.

Post-normal science makes it scientifcally possible to incorporate community experiential knowledge into the HIA process and provide justification for the importance of community knowledge and how this knowledge makes impact assessments more robust, rigourous and relevant.

Who's afraid of community consultation?

Consulting local communities and other stakeholders as part of developing new plans and projects can be a difficult process. But it needn’t be so.

Communities are not scary, incomprehensible and unpredictable aliens from outer space! They are just like you and me. They have the same aspirations and dreams and the same worries and anxieties for their families and neighbourhoods that we all have.

Here are twenty top tips to help you make community consultation a rewarding, involving and engaging experience.

Do:

• Know your audience.
• Make sure you know why you are consulting, engaging or involving.
• Make sure you let everyone else know why you are consulting, engaging or involving.
• Be truthful even if that means saying “I don’t know”.
• Then find out what you don't know and get back to them with an answer.
• Be yourself.
• Plan for how things might go wrong.
• Smile, make eye contact and be warm.
• Recognise that consultation and involvement generates uncertainty and unpredictability – for you and them.
• Listen, listen and listen.

Don’t:

• Ever promise what you can’t deliver.
• Start consulting without getting agreement on a clear plan of action.
• Assume that everyone in the team knows what they’re supposed to be doing.
• Be disrespectful to people or their views.
• Lose your cool.
• Walk away leaving people feeling dissatisfied or aggrieved.
• Finish the consultation without letting people know what the next steps are.
• Get scared. Each consultation is unique and we all make mistakes.
• Take comments at face value. If you have the chance, ask people why they’ve said what they have and what evidence they have to support it.
• Forget to say “Thank you”.

Further Information: A Ladder of Citizen Participation - Sherry R Arnstein

Cost Benefit Analysis of HIA

The UK Department of Health has published a cost benefit analsysis of HIA. From the abstract:

"The report sets out the findings of the cost benefit evaluation of Health Impact Assessment. York Health Economics Consortium followed 16 HIAs looking at the process, impact, outcomes and costs and benefits of HIA. The findings show the benefits outweigh the costs, although it was a small sample. The report will be subject to further consideration and comments are welcome."

Many of the issues identified in the report will be familiar to HIA practitioners. What is perhaps most interesting is the large variation in the amounts spent on conducting the HIAs - ranging from £1,107 to £65,240.

Where does HIA fit best within the policy and planning cycle?

I’d like to stimulate some debate about where people see HIA best fitting within the planning cycle (following on from the interesting recent blog discussion on HIA as a scientific tool).

In New South Wales, HIA is seen as adding most value as a prospective tool at a specific point in the planning cycle; after a draft proposal has been developed but before implementation.

However, recently we’ve been approached to use HIA as a tool to assist with planning for health earlier in the cycle. This raises a number of issues:

First, should or can HIA be a substitute for good needs assessment and problem identification? Or can HIA become a useful needs assessment / problem identification tool? Work with communities on regeneration projects in Victoria has indicated this may be the case.

Second, developing a draft proposal takes time and effort. How can HIA be integrated with this time and effort while planning decisions are being made rather than afterward as a check on those decisions? Would this be a better way of ensuring health impacts are considered? At a recent training course Ben and I attended in Thailand, it was suggested that HIA can stretch itself earlier in the planning cycle to assist with developing different options and their potential impacts before the proposal is drafted.

Third, what are some other approaches and methods the HIA can use or add to earlier on in the planning cycle? For example, at a recent meeting we had with Urban Planners, it was suggested that as Health professionals we need to understand how private sector developers plan and develop proposals (i.e. through market analysis).

Finally, while I am open to HIA being used earlier in the planning cycle, I would take more convincing concerning the use of HIA as a retrospective tool that replaces evaluation.

What do others think?