11th HIA Conference - Pre-conference workshop and 'networking' photos

Yes, I really was networking and learning! A really lovely day and the Andalusian School and Granada are very cool (as I'm sure you'll agree).

Dynamo workshop

Morning coffee break

Quantitative afternoon workshop I

Quantitative afternoon workshop II

Afternoon coffee break

Quantitative afternoon workshop IV

Heading out for an evening out

 At the Plaza Nueva

Paseo del Padre Manjon view up to Al Hambra

Tapas and drinks at the Paseo del Padre Manjon

Night view of the Al Hambra

3rd plenary - Gareth Williams, Wales; Nicole Valentine, Switzerland; Sarah Simpson, Italy; Stephen Linter, United States

Health inequalities, social justice and HIA

"...Things fall apart, the centre cannot hold
Mere anarchy is loosed upon the world
...
The best lack all conviction,
while the worst have passionate intensity..."

HIA is about dialogue between different stakeholders and engaging with different values

Conceptual framework for social determinants of health - which theory is the basis of a tool for HIA

SDH is based on theories of "social production of disease"

Policies on determinants of health do not necessarily tackle determinants of health inequalities

Root causes of health inequalities - systematic unequal distribution of power (social, political, economic) i.e. social position and the exposures this generates

Distal/Structural determinants = policies (more difficult to implement socially and politically)
Intermediate determinants = material resources, ...

Need broad commitment to the SDH model.

Need to strengthen health governance to address the SDH and related health inequities - lessons from Europe

Most social and global problems are 'wicked problems' difficult to tame.

Role of governance in enhancing equity and improving health - how governments and other organisations interact, relate to citizens and decide.

Adelaide Statement on Health in All Policies (HiAP) - shared governance for health and wellbeing.

HIA is a key approach in HiAP

Key pieces of WHO work:
1. Setting the political agenda to tackle health inequity in Norway, Slovenia and Scotland (published soon).
2. Online knowledge base on health system actions to tackle social determined health inequalities
3. Synthesis document

Lessons:
1. Analyse context
2. A tool to assess and strengthen governance capacity
3. Know the different levels of governance - cooperation (joint working group), coordination (advisory board to a government department, have resources), integrated policies (joint new policies)

We need to be specific about what level health inequalities is being tackled in relation to horizontal governance.

Challenge of managing crises in a rapidly changing world

Big issues for the World Bank
Economic
Food
Climate

Strategic assessments are an important part of work

Protecting pro-poor health services during financial crisis - real spending can decline, weak fiscal policies mean these are cut first, reduce overseas assistance from higher income countries

Effective interventions - broad strategies, targeted interventions and social safety net

Cost of Environmental Degradation, new book on economic impacts of adverse environmental change. Case studies e.g. 18% of impacts are on health in Tunisia.


What we need to do:
Integration
Innovation
Implementation

Adapt to changing circumstances. Interaction with affected communities is important.

2nd Plenary - Official Opening - Jesus Fernandez, DHM, Basque Government & Enrique Cruz, DHM, Andalusian Government

Impressed with the range and quality of the workshops going on during the conference. Commend the HIA conference organisers and the Andalusian School.

Important time for public health in Europe and globally both in terms of the economic crisis and natural disasters e.g. in Japan.

Window of opportunity to develop new approaches and better lik health and sustainability and for health systems to think about health in all policies.

Make health systems more cohesive and reduce inequalities and improve all people's health, a democratic and healthy society.

Good health is good for investment, human capital, entrepreneur, social development and part of the democratic fabric. Developing a new approach that looks to involve citizens in developing policy. New public health legislation and the use of HIA in policy-making in Andalusia.

1st Plenary Speaker - Adela Cortina "Yes, We Can"

This conference should be built on rock (echoing Obama campaign slogan and his speech at Georgetown).

Corporate Social Responsibility - seen as a cosmetic or philanthropy instead should be seen as a management tool, an element for prudence and an element for justice. Change the mindset of the core management of private enterprise.

Co-operation - Need to generate more friends than enemies, worst thing we can do is create more enemies and conflict e.g. engage with economists and business.

Dignity of people - Seeing people as ends and not means, as full of dignity and valuable in themselves. They have their own interests that need to be acknowledged. They are not commodities and should not be treated as such.

Commitment - To train public health professionals as citizens, what is the difference between professionals and technicians, who has ideals and is integrated into society - to prevent what we cannot cure and help promote peace. A global citizen professional.

Values - All human activities involve values and morals, about creating the good society, a safer and better world, even when it is denied they are there.

Adela Cortina is a professor at the Department of Moral and Political Law Philosophy at Valencia University and Etnor Foundation, Spain.

11th HIA Conference - Live Streaming

Hi Folks, 

I thought I'd try some fairly live blogging at the conference (the beauty of free wifi, thanks to the Andalusian School of Public Health).


You can access it through the conference website http://www.hiainternationalconference.org


Or directly at: http://si.easp.es/eis2011/



The videos of all plenary sessions will be available to watch online a few days after the conference. Please, feel free to disseminate this information among your colleagues and networks.


Courtesy of Ana Rivadeneyra, Conference Secretariat

Preserve welfare spending to protect population health, not health budgets

There's a fascinating argument in the recent BMJ that efforts should be devoted to ring-fencing

Governments may feel they are protecting health by safeguarding healthcare budgets, yet David Stuckler, Sanjay Basu, and Martin McKee argue that social welfare spending is as important, if not more so, for population health.

Access Article

David wrote a piece for the International Association for Impact Assessment's Health Quarterly in 2009 on the health impacts of the global financial crisis that's worth reading too.

Hat-tip to Malcolm Lewis for the article.

Health and the Environment: A compilation of evidence

The Australian Institute of Health and Welfare has released a useful summary of the links between health and the environment:

Why look at environment and health?

There is increasing awareness that our health and the environment in which we live are closely linked, and in 2006 the World Health Organization (WHO) estimated that 24% of the global burden of disease was due to modifiable environmental factors. This growing awareness is reflected in recent health and environmental initiatives from governments and other organisations.

How does this report help?

Given the abundance and diversity of literature, it is useful to summarise and increase access to information regarding health and the environment. As new evidence is constantly emerging, this report does not seek to provide definitive conclusions about this relationship. Rather, it draws upon key studies and synthesises the main findings related to a selected list of 15 environmental factors. The report also notes that it can be difficult to assess the relationship between health status and environmental factors for a number of reasons.

What are the main findings?

Overall, the report indicates that the environment can be a major determinant of our health and how we live. In general, the results reported here demonstrate that:

• Our surroundings can influence our health through a variety of channels—through exposure to physical, chemical and biological risk factors or by triggering changes to our own behaviour or the behaviour of those around us. Such effects may be direct (such as injury or death) or indirect (through changes in lifestyle and health behaviours).
• The environment has the potential to affect physical health (for example, respiratory problems due to air pollution) and mental wellbeing (for example, poor mental health associated with drought conditions). Conversely, there are natural and modified features of the environment (such as green space and water fluoridation) which benefit health.
• There is a growing awareness that humans, through their intervention in the environment, play a vital role in exacerbating or reducing health risks.

Examples of the report’s detailed findings include:

• From official records, bushfires killed 815 people in Australia between January 1851 and December 2010 (see Section 3.3).
• A large study found that people living in more walkable neighbourhoods (characterised by connected streets, high residential density and pedestrian-oriented shopping) were less likely to be obese than people living in less walkable areas (see Section 4.3).
• A study using data from the National Health Survey showed that overcrowding was responsible for 30% of the health gap between Indigenous adults living in remote areas and the non-Indigenous population (see Section 4.7).

What don’t we know?

There is a lack of data on exposure to environmental hazards and health outcomes, particularly at a local level. As such, the health effects of many aspects of the environment have not been systematically evaluated, and there is associated uncertainty about causality because the pathways involved may be indirect and complex. Despite these limitations, this report provides insight into the relationship between the environment and health

The data is quite focused on the Australian context but it's still well worth a look. You can download the report here.

Forthcoming Book on Health Impact Assessment: Principles and Practice

Our friend Martin Birley has a book on HIA coming out:

"The purpose of this book is to fill this gap and to introduce the subject of Health Impact Assessment using plain language, in both general and specific contexts and with reference both to market and less developed economies. As a result, the reader should be able to describe what HIA can and cannot achieve, identify the components of a successful HIA and participate in an assessment as a member of a team. Examples are provided from a number of planning and development sectors, including extractive industry, water resource management, and housing. The reader, whether student or professional, need not be a health specialist, although prior knowledge of some public or environmental health would be an advantage."

“To many people, Health Impact Assessment is a new concept requiring new skills. A pioneer and global expert in the subject, Dr Birley has been grappling successfully with this challenge for many decades. His book reveals extraordinary experience and insight, providing depth and context to existing HIA guidelines, invaluable to those who are trying to use them."

Sir Michael Marmot,
Professor of Epidemiology & Public Health, Chair of the Commission on Social Determinants of Health and current president of the BMA

“I warmly commend this book. Apart from being by far the most useful work on how to operationalize Health Impact Assessment, the book is brilliantly comprehensive and a profoundly wise distillation of the author’s unparalleled experience worldwide.”

Dr Robert Goodland,
former Senior Environmental Advisor at the World Bank and former president of the International Association for Impact Assessment

It looks like it will be a great read and useful to everyone with an interest in HIA. You can find out a lot more about the book here.

It's also being launched at the HIA Conference in Granada so please make sure to drop by if you're attending.

Updated: The IAIA Health Key Citations Series

Key Citations Series - Health. Fargo ND: International Association for Impact Assessment, 2011.

iaia.org/publicdocuments/Activity_Resources/Key_Citations/Key%20Citations_HIA%2011%20Jan.pdf

Psychosocial impact of floods

There's an interesting article in BMC Public Health (open access) about the psychosocial impact of the 2007 England floods. It seemed quite timely given the recent major flooding in Bazil and Australia.

Background
The summer of 2007 was the wettest in the UK since records began in 1914 and resulted in severe flooding in several regions. We carried out a health impact assessment using population based surveys to assess the prevalence of and risk factors for the psycho-social consequences of this flooding in the United Kingdom.

Methods

Surveys were conducted in two regions using postal, online, telephone questionnaires and face-to-face interviews. Exposure variables included the presence of flood water in the home, evacuation and disruption to essential services (incident management variables), perceived impact of the floods on finances, house values and perceived health concerns. Validated tools were used to assess psycho-social outcome (mental health symptoms): psychological distress (GHQ-12), anxiety (GAD-7), depression (PHQ-9) and probable post-traumatic stress disorder (PTSD checklist-shortform). Multivariable logistic regression was used to describe the association between water level in the home, psychological exposure variables and incident management variables, and each mental health symptom, adjusted for age, sex, presence of an existing medical condition, employment status, area and data collection method.

Results

The prevalence of all mental health symptoms was two to five-fold higher among individuals affected by flood water in the home. People who perceived negative impact on finances were more likely to report psychological distress (OR 2.5, 1.8-3.4), probable anxiety (OR 1.8, 1.3-2.7) probable depression (OR 2.0, 1.3-2.9) and probable PTSD (OR 3.2, 2.0-5.2). Disruption to essential services increased adverse psychological outcomes by two to three-fold. Evacuation was associated with some increase in psychological distress but not significantly for the other three measures.

Conclusion

The psychosocial and mental health impact of flooding is a growing public health concern and improved strategies for minimising disruption to essential services and financial worries need to be built in to emergency preparedness and response systems. Public Health Agencies should address the underlying predictors of adverse psychosocial and mental health when providing information and advice to people who are or are likely to be affected by flooding.

Link

Climate Shocks: Turning Crisis into Opportunity

An interesting, if somewhat pessimistic lecture by Thomas Homer-Dixon on the impending (if not current) climate shocks and the opportunities they may afford us. Abstract:

"Climate policy is gridlocked nationally and globally, with virtually no chance of a breakthrough under current conditions. Policy makers need to accept that societies will not make drastic changes to address climate change until a climate crisis hits. The recent financial crisis showed that when powerful special interests have convinced much of the public that what they are doing is not dangerous, only a disaster that discredits those interests will provide an opportunity for comprehensive policy change. Societies that have response plans on the shelf will be far better off than those that are blindsided. The task for national and regional leaders, then, is to develop a set of contingency plans for possible climate shocks — what we might call, collectively, Plan Z. Such a plan should include detailed scenarios of plausible climate shocks; close analyses of options for emergency response by governments, corporations and nongovernmental groups; and clear specifics about what resources — financial, technological and organizational — we will need to cope with different types of crises."

Presentation and audio and video downloads

New Austrian Website on Health Impact Assessment

CNBC Financial Report on "Externalities"...

CNBC's Larry Kudlow on the earthquake in Japan:
"The human toll here looks to be much worse than the economic toll and we can be grateful for that."

Upcoming Webinar: What Shapes Health?

The Robert Wood Johnson Foundation is organising a webinar on "What Shapes Health?" The program will look at:

• How do early life experiences affect health throughout life?
• How important is health education in shaping healthy behaviours?
• How does stress in early childhood affect the brain and other organs, with lifelong consequences for health?
• What can policy-makers and advocates do to reduce health care costs and improve lifelong health for all Americans?

There's an impressive line-up of speakers, including David Williams, Paula Braveman, Susan Egerter and Jack Shonkoff.

Details:
2:00pm-3:30pm US Eastern Time 24 March 2011
Register here

USA: HIA Funding Opportunity with the Health Impact Project

The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, is accepting brief proposals through June 1, 2011 for grants to conduct health impact assessments (HIAs). The funding will enable awardees to develop an HIA, which is a study that can help policy makers and community members identify and address the potential, and often-overlooked, health implications of proposed policies and projects in a broad range of sectors, such as agriculture, energy, transportation and development.

The Health Impact Project will fund up to eight HIAs to identify how policy proposals will impact health at the local, tribal or state levels. Grants will range from $25,000 to $125,000 and will support government agencies, educational institutions and nonprofit organizations.

For more information and to apply online, visit www.healthimpactproject.org.

USA HIA Update from Human Impact Partners

This is an excerpt of the Human Impact Partners' February update.

Project Updates

Our work to complete HIA projects has definitely picked-up over the past few months. While 2010 was the year of HIA training and technical assistance, it seems that 2011 is the year of HIP completing some exciting and innovative HIAs of our own.

For example, with a generous grant from The California Endowment, HIP has launched into an intensive assessment phase in our School Discipline Health Impact Assessment. To date, HIP has developed a scope for the HIA; is conducting a quantitative analysis of how Positive Behavioral Interventions and Supports (PBIS) as a discipline policy and practice affects suspensions, expulsions, and graduation rates; and is collecting qualitative data on violence, mental health, and social cohesion outcomes as they relate to various school discipline approaches. Using Oakland, Los Angeles and Salinas as case studies, and working with local partners such as CADRE in Los Angeles, we hope that the HIA will contribute to ongoing campaigns and efforts to address the “school to prison pipeline.”

On the built environment HIA front, HIP continues to make progress on the I-710 Corridor HIA and the Lake Merritt BART Station Area Plan HIA.

In terms of new HIA projects, HIP is excited to be working with the Robert Wood Johnson Foundation/Pew Charitable Trusts’ Health Impact Project to scope an HIA on the next federal farm bill. At the local level, HIP began working with the Legal Aid Foundation of Los Angeles on a rapid HIA of the proposed Long Beach Downtown Community Plan. The HIA will have a specific focus on assessing plan impacts to affordable housing, displacement, and employment opportunities.

HIP’s technical assistance work continues as well, and we have several exciting new partnerships to support. The City of Philadelphia’s “Get Healthy Philly” program (funded through the American Recovery and Reinvestment Act) has asked HIP to support the Health and Planning Departments as they conduct HIAs on local district (i.e., area/community) plans. The California Department of Public Health has also asked HIP to mentor three county public health departments in California as they complete rapid HIAs on grocery retail models (Alameda), a redevelopment plan (Fresno), and a regional transportation plan (San Mateo). Last, we are providing TA to the Planning Department in Northampton, Massachusetts as they conduct an HIA on policies to improve access to healthy food.

Institutionalizing Health Impact Assessment

Through all of our work, we are encouraged by the openness of government agencies at local, state and federal levels to HIA concepts. Increasingly, agencies want to incorporate health earlier in their decision-making processes and are looking to HIA to provide a model for accomplishing their public health program goals. Given this interest, HIP recently completed a draft HIA plan that identifies core strategies and activities to institutionalize HIA within various levels of government. The primary strategies promoted in the plan include:

1. advancing an educational campaign to build support for prescriptive requirements for HIA,
2. integration of HIA in environmental impact assessment practices, and
3. working with governmental institutions to voluntarily implement HIA practices (for example, through Health in All Policies approaches).

Through an intensive outreach effort to public health, planning and equity partners across the community-based, advocacy and government spectrum, HIP received feedback on the core strategies in the institutionalization plan and prioritized a set of activities to guide this work over the next one to two years. If you are interested in getting involved in these efforts, please let us know – we would be happy to work with those who are willing! We recognize that the path to institutionalizing HIA, and getting health incorporated in decision-making more broadly, requires partnerships at all levels and we welcome the opportunity to work with individuals and organizations that are committed to advancing this work.

Society of Practitioners of Health Impact Assessment (SOPHIA)

As part of HIP’s continuing work with HIA practitioners in North America, we are excited to announce the start of a new HIA practitioners group which grew out of the March 2010 HIA of the Americas meeting co-hosted by HIP. The Society of Practitioners of Health Impact Assessment (SOPHIA) will be an association of individuals and organizations providing leadership and promoting excellence in the practice of health impact assessment. The increasing number of HIA practitioners and demand for more formal networking structures and standards for practice drove the development of a formal association. Currently, a provisional steering committee has been formed (with Jonathan as Chair) and subcommittees have begun meeting to develop bylaws, engage potential members (including those outside North America), begin shaping SOPHIA’s activities for members, and plan the next HIA of the America’s conference (October 3 & 4 in Oakland). If you are interested in getting involved in SOPHIA, please contact any one of us and we will be happy to include you as the association is launched.

Conferences

In 2010, HIP staff presented at over 15 conferences across the country. We think this is a result of the growing excitement in the U.S. about HIA. One highlight was the American Public Health Association (APHA) annual meeting in Denver, where, in addition to participating in other sessions, HIP organized and moderated a panel on HIA. The session was moderated by Lili and included a diverse set of perspectives, including Angelo Logan from East Yard Communities for Environmental Justice, Aaron Wernham from the Health Impact Project, and Marnie from HIP. The session was a big success and as a result we’ve been invited to submit a session proposal for the 2011 APHA annual meeting.

Similarly, at the New Partners for Smart Growth Conference this past month, HIP presented at two well attended sessions on HIA: one focused on the use of health based information and health impact assessment to shape local planning processes in San Mateo County; and the other, a half-day session, introduced HIA and examples of its application from around the country.

Resources and Announcements

We wanted to share some exciting new HIA resources and announcements that may be useful to you:

• Authored by HIP co-founder and Board member, Dr. Rajiv Bhatia, the CA Department of Public Health recently published “A Guide for Health Impact Assessment.” The intent of the Guide is to support current and prospective practitioners of HIA in California and the United States, to foster thoughtful and high-quality use of HIA, and to promote consideration of health in all policies. The Guide is available here: http://www.cdph.ca.gov/pubsforms/Guidelines/Documents/HIA%20Guide%20FINAL%2010-19-10.pdf
• As part of its public health and transportation toolkit, the American Public Health Association recently published a fact sheet to respond to the growing interest in applying HIA methods and tools to transportation projects. The fact sheet is available here: http://www.apha.org/NR/rdonlyres/1CD24FFB-37FB-4576-86A1-6D68A1C5DBAF/0/APHAHIAFactsheetJan2011.pdf
• The Centers for Disease Control and Prevention recently released a grant announcement “Health Impact Assessment to Foster Healthy Community Design.” The purpose of the grant is to increase the capacity of state, tribal and local governments to include health considerations in community development, transportation, housing, and land use planning decisions, and to expand the scope of health impacts considered when making decisions that impact community design. Information on the grant announcement can be found here: http://www.grants.gov/search/search.do?mode=VIEW&oppId=66533

-Casey, Celia, Holly, Jen, Jonathan, Kim, Lili, Marnie, Rachana