1. Numbers in superscripts refer to references on last slide Health Impact Assessment Gabriel Gulis, PhD University of Southern Denmark Institute of Public Health Unit of Health Promotion Research Niels Bohrvej 9-10 6700 Esbjerg Denmark Telephone: +45 65504212 Telefax: +45 65504283 E-mail: ggulis@health.sdu.dk

2. Learning objectives To get familiar with the health impact assessment To get familiar with the health impact assessment To understand the objectives of health impact assessment To understand the objectives of health impact assessment To understand basic methodological steps of health impact assessment To understand basic methodological steps of health impact assessment

3. Performance objectives To be able to recognize a need for health impact assessment To be able to recognize a need for health impact assessment To be able to outline a health impact assessment for the selected case To be able to outline a health impact assessment for the selected case To be able to establish a team for conduct of health impact assessment To be able to establish a team for conduct of health impact assessment

4. Why do I like health impact assessment ? I was used to work in hygiene service in Slovak Republic and it had been required by law since 1966 that each decision should be approved by district hygienist, it means some kind of health impact assessment had been expected. Unfortunately, the practice was not always so. Working as director of the National Health Promotion Center, I realized that health impact assessment is much more then a step within licensing procedure and I started to do research in this field. The broad field which must be covered and the variety of inter-relations explored by a truly health impact assessment is an amazing field of public health with no respect to national or local level or selected topic to assess.

5. Health impact assessment (HIA) Environmental, social, economic, etc. impact assessments Environmental, social, economic, etc. impact assessments Assessment – evaluation Assessment – evaluation Health impact assessment - any combination of procedures or methods by which a proposed policy or program may be judged as to the effects it may have on the health of a population 3 Health impact assessment - any combination of procedures or methods by which a proposed policy or program may be judged as to the effects it may have on the health of a population 3

6. Health impact assessment Health impact assessment - a methodology which enables the identification, prediction and evaluation of the likely changes in health risk, both positive and negative, single or collective, of a policy programme, plan or development action on a defined population. These changes may be direct and immediate or indirect and delayed Health impact assessment - a methodology which enables the identification, prediction and evaluation of the likely changes in health risk, both positive and negative, single or collective, of a policy programme, plan or development action on a defined population. These changes may be direct and immediate or indirect and delayed

7. HIA development EIA legislation – 1969 EIA legislation – 1969 1991 and later in 90’s more and more countries includes HIA into expertise's, New Zealand, Australia, British Columbia in Canada, etc. 1991 and later in 90’s more and more countries includes HIA into expertise's, New Zealand, Australia, British Columbia in Canada, etc. In Europe Germany and the Netherlands mostly environmental health issues, Finland, Sweden other general policy or specific policy issues in 90’s In Europe Germany and the Netherlands mostly environmental health issues, Finland, Sweden other general policy or specific policy issues in 90’s 1998 strong movement in United Kingdom, major documents came out 1998 strong movement in United Kingdom, major documents came out Epidemiology, environmental health, risk assessment, sociology, politology, communication, etc. Epidemiology, environmental health, risk assessment, sociology, politology, communication, etc.

8. Amsterdam treaty of EC article 152 ”a high level of human health protection shall be ensured in the definition and implementation of all Community policies and activities” ”a high level of human health protection shall be ensured in the definition and implementation of all Community policies and activities” –http://ue.eu.int/Amsterdam/en/traiteco/en1.htm http://ue.eu.int/Amsterdam/en/traiteco/en1.htm –TITLE XIII Article 152 European council resolution of June 1999 calls for establishment of procedures to monitor the impact of Community policies and activities on public health and health care European council resolution of June 1999 calls for establishment of procedures to monitor the impact of Community policies and activities on public health and health care

9. Gothenburg consensus paper Values governing HIA: Values governing HIA: –Democracy –Equity –Sustainable development –Ethical use of evidence Elements of HIA Elements of HIA –Evidence –Opinions –Informed understanding –Adjustment/options

10. HIA of the EU Common Agriculture Policy Dahlgren, Nordgren, Whitehead, National Institute of Public Health, Sweden, 1996 21 Dahlgren, Nordgren, Whitehead, National Institute of Public Health, Sweden, 1996 21 Health impacts of Health impacts of –CAP of fruit and vegetable –CAP of diary products –CAP of tobacco regime –CAP of alcohol regime

11. The cases listed on the following five slides refer to different topics HIA has been completed Merseyside steering group Community safety projects 5 Community safety projects 5 International astronomy and space exploration centre 14 International astronomy and space exploration centre 14 Integrated transport strategy 5 Integrated transport strategy 5 Drug prevention initiative 5 Drug prevention initiative 5 King George V playing fields project 5 King George V playing fields project 5 And many others 5 And many others 5

12. Edinburgh City of Edinburgh Council’s Urban Transport strategy 5 City of Edinburgh Council’s Urban Transport strategy 5 North Edinburgh area renewal housing strategy 5 North Edinburgh area renewal housing strategy 5

13. London Greater London Authority’s Biodiversity Strategy 5 Greater London Authority’s Biodiversity Strategy 5 Greater London Authority Economic Development Strategy 5 Greater London Authority Economic Development Strategy 5

14. Impact of US embargo on health in Cuba Combine effects of a severe economic decline since 1989 and a tightening of the US embargo in 1992 on health and health care in Cuba 16 Combine effects of a severe economic decline since 1989 and a tightening of the US embargo in 1992 on health and health care in Cuba 16

15. Waste management and airports Waste management and airports Health impact of Nant-y-Gwyddon landfill site 5 Health impact of Nant-y-Gwyddon landfill site 5 Solid waste facilities in Canada 5 Solid waste facilities in Canada 5 Third runway at Sydney’s Kingsford-Smith Airport 5 Third runway at Sydney’s Kingsford-Smith Airport 5 Manchester airport 5 Manchester airport 5 Schiphol airport Amsterdam 5 Schiphol airport Amsterdam 5

16. HIA methodologies 16 different models or guidance's recognized in literature! 16 different models or guidance's recognized in literature! The Merseyside guidelines 1 The Merseyside guidelines 1 A 10 step risk assessment model of the University of Bielefeld 20 A 10 step risk assessment model of the University of Bielefeld 20 General model 20 General model 20

17. The Merseyside guidelines Apply screening criteria to select project or policy Apply screening criteria to select project or policy Establish steering group Establish steering group Agree terms of reference for assessment Agree terms of reference for assessment Select assessor Select assessor Conduct assessment Conduct assessment Appraise the assessment Appraise the assessment Negotiate favored options Negotiate favored options Implement and monitor Implement and monitor Evaluate and document Evaluate and document

18. The Merseyside guidelines – assessment step Conduct assessment Conduct assessment –Policy analysis –Profiling of communities –Interview stakeholders and key informants –Identify health determinants affected, collect evidence from previous reports –Assess evidence –Establish priority impacts –Recommend and justify options for action

19. A 10 step risk assessment model (Bielefeld model) Project analysis Project analysis Regional analysis Regional analysis Population analysis Population analysis Background analysis Background analysis Prognosis of additional pollution Prognosis of additional pollution Prognosis of health impact Prognosis of health impact Summarizing assessment of impacts Summarizing assessment of impacts Recommendations Recommendations Communication Communication Evaluation Evaluation

20. General model Screening Screening Scoping Scoping Risk assessment Risk assessment Decision making Decision making Implementation and monitoring Implementation and monitoring

21. Screening Preliminary assessment to see if the project or policy is likely to pose any significant health questions and is therefore worth to subjecting to health impact assessment Preliminary assessment to see if the project or policy is likely to pose any significant health questions and is therefore worth to subjecting to health impact assessment –Positive or negative expectations?

22. Scoping Outlining the possible hazards and benefits and identifying the questions that must be asked in the assessment process Outlining the possible hazards and benefits and identifying the questions that must be asked in the assessment process Frequently referred to as ”setting of terms of reference” Frequently referred to as ”setting of terms of reference” –Baseline level? –What would happen if the funds needed to implement the assessed project or policy will be devoted to other project or policy?

23. Risk assessment Characterization of nature and magnitude of harmful and beneficial factors Characterization of nature and magnitude of harmful and beneficial factors How many and which people will be affected by them How many and which people will be affected by them How they will be affected How they will be affected Negative factors – mitigation Negative factors – mitigation Positive factors - maximalization Positive factors - maximalization

24. Decision making Choice of options, including no action option Choice of options, including no action option Final recommendation including mitigation or maximalization strategies Final recommendation including mitigation or maximalization strategies

25. Implementation and monitoring Recommendation of actions to implement decision and to observe the consequences Recommendation of actions to implement decision and to observe the consequences Monitoring and communication Monitoring and communication Evaluation and communication Evaluation and communication

26. Key problems Levels – individual, social group, community, region, country, international Levels – individual, social group, community, region, country, international Measures – what kind of measures on which step Measures – what kind of measures on which step Stakeholders –health professionals, other professionals, community, public, etc. Stakeholders –health professionals, other professionals, community, public, etc. QA/QC QA/QC Political acceptance (community) – why some politicians ask for HIA and others do not Political acceptance (community) – why some politicians ask for HIA and others do not Prospective versus retrospective Prospective versus retrospective

27. Literature and information sources 1. www.ihia.org.uk www.ihia.org.uk 2. http://www.msoc-mrc.gla.ac.uk/Reports/PDFs/Occasional-Papers/OP-002.pdf http://www.msoc-mrc.gla.ac.uk/Reports/PDFs/Occasional-Papers/OP-002.pdf 3. http://www.who.dk/eprise/main/WHO/Progs/HPA/HealthImpact/20020319_1 http://www.who.dk/eprise/main/WHO/Progs/HPA/HealthImpact/20020319_1 4. http://www.hc-sc.gc.ca/hppb/healthpromotiondevelopment/pube/impact/impact.htm http://www.hc-sc.gc.ca/hppb/healthpromotiondevelopment/pube/impact/impact.htm 5. http://www.publichealth.bham.ac.uk/hiaru/ http://www.publichealth.bham.ac.uk/hiaru/ 6. http://www.euro.who.int/eprise/main/WHO/Progs/HMS/Home http://www.euro.who.int/eprise/main/WHO/Progs/HMS/Home 7. Lerer LB: Health impact assessment, Health Policy and Planning, 14(2), 198-203 8. Kemm J.: Health impact assessment: a tool for Healthy Public Policy, Health Promotion International, Vol 16, No.1, 79-85 9. Beecham L: All policies should be assessed for effect on health, BMJ, 1998; 316: 1558 10. Parry J., Stevens A: Prospective health impact assessment: pitfalls, problems, and possible ways forward, BMJ, 2001; 323: 1177-82 11. Mittelmark MB: Promoting social responsibility for health: health impact assessment and healthy public policy at the community level, Health Promotion International, Vol. 16, No. 3, 269-274 12. Mooy JM, Gunning-Schepers LJ: Computer-assisted health impact assessment for intersectoral health policy, Health Policy 57 (2001), 169-177 13. Mindell J, Hansell A., Morrison D., Douglas M, Joffe M: What do we need for robust, quantitative health impact assessment, Journalm of Public Health Medicine, Vol. 23, No. 3, p. 173-178 14. Winters LY: A prospective health impact assessment of the international astronomy and space exploration centre, J. Epidemiol Community Health, 2001; 55: 433-441 15. Douglas MJ, Conway L, Gorman D, Gavin S, Hanlon P: Developing principles for health impact assessment, Journal of Public Healt medicine, Vol. 23, No. 2, p. 148-154 16. Garfield R, Santana S: The impact of the economic crisis and the US embargo on health in Cuba, American Journal of Public Health, Vol. 87, No. 1, p. 15-20 17. Mahoney M, Morgan RK: Health impact assessment in Australia and New Zealand: an exploration of methodological concerns, Promot. Educ. 2001, 8(1), 8- 11 18. Scott-Samuel A: Health impact assessment-theory into practice, J. Epidemiol Community Health, 1998; 52:704-705 19. Scott-Samuel A: Health impact assessment, BMJ 1996; 313: 183-184 20. Developing health impact assessment in Wales, Better Health Better Wales, National Assembly of Wales, Health Promotion Division, ISBN 0 7504 2374 9 21. Dahlgren G, Nordgren P, Whitehead M: Health impact assessment of the EU Common Agricultural Policy, National Institute of Public Health, 1997:36, Stockholm, Sweden 22. http://www.stakes.fi/sva/huia/huiainstakes.htm http://www.stakes.fi/sva/huia/huiainstakes.htm 23. Banken R: Strategies for institutionalizing HIA, ECHP Health Impact Assessment Discussion papers, Number 1, September 2001