Marco Martuzzi World Health Organization Regional Office for Europe Health Impact Assessment as part of SEA

Rationale Question: Question: –“What is the evidence on …”? –“What is the best course of action to protect and maximise health?” Rapid advancement of technology Rapid advancement of technology Organisation of society increasingly complex Organisation of society increasingly complex Multiple, complex pathways to health Multiple, complex pathways to health

Why HIA? Increasing awareness of complex “web of causation” to health Increasing awareness of complex “web of causation” to health Many determinants are not in the health sector Many determinants are not in the health sector Limitations in traditional risk assessment paradigm to inform decision making in E&H Limitations in traditional risk assessment paradigm to inform decision making in E&H Growing demand for policies that are: Growing demand for policies that are: –evidence based (in general and health-wise) –developed through participatory processes

Definition of HIA “A combination of procedures, methods, and tools by which a policy, programme, or plan may be judged as to its potential effects on the health of population and the distribution of those effects within the population” (Gothenburg consensus paper, WHO 1999).  E.g., from air pollution to transport policies

Many HIA methods – but all similar Based on broad model of health Based on broad model of health Multi disciplinary, inter sectoral Multi disciplinary, inter sectoral Equity focus - inequalities or vulnerable groups Equity focus - inequalities or vulnerable groups Incorporate a range of quantitative and qualitative methodologies and evidence Incorporate a range of quantitative and qualitative methodologies and evidence Flexibility in depth of analysis Flexibility in depth of analysis Usually prospective Usually prospective  Substantial overlap with EIA and SEA

Positive results of the HIA process Provides a mechanism for health to inform decision making Provides a mechanism for health to inform decision making Improves inter sectoral working Improves inter sectoral working Encouraging public participation in decision making Encouraging public participation in decision making Influences decisions Influences decisions

HIA at strategic level Move from “environment” to sustainable development – “upstream” determinants Move from “environment” to sustainable development – “upstream” determinants Strong political drive (e.g., art 152, London Declaration) Strong political drive (e.g., art 152, London Declaration) Strategic, sectoral level of increasing interest Strategic, sectoral level of increasing interest Still few applications address health in a comprehensive way Still few applications address health in a comprehensive way SEA protocol: an excellent opportunity SEA protocol: an excellent opportunity

Strategic level HIAs Employment policy of EU Employment policy of EU Agriculture Agriculture –CAP in Slovenia –Direct involvement of government –Resulted in influential outcome Transport Transport –Scoping –Methodology and tools for integrated modelling

HIA as part of SEA: specific questions? Methodological Methodological –Social determinants of health often outweigh other determinants, e.g. of bio-physical environment –Interactions –When assessing changes in broad policies, consequences can be far-reaching –Beneficial effects

HIA as part of SEA: specific questions? Conceptual Conceptual –Different aims of HIA: estimate impact; expand evidence base to involve stakeholders; influence policy –More complex trade-offs –WHO’s definition of health

HIA as part of SEA: specific questions? Institutional Institutional –Who does HIA? –Monitoring and follow-up of health –Promotion with health sector

What does the SEA protocol mean for HIA Promote a greater integration of HIA and SEA procedures and practice Promote a greater integration of HIA and SEA procedures and practice –Exchange and consolidation of frameworks and approaches for HIA and SEA –Map and clarify overlaps in the determinants of health and environment, identify main points of contact –Compare HIA and SEA practice, what is considered by both, added value of bringing them together

Next steps WHO strongly committed to HIA and related approaches WHO strongly committed to HIA and related approaches Stronger link between health and environment desirable – SEA protocol provides an opportunity Stronger link between health and environment desirable – SEA protocol provides an opportunity Methodological work and applications needed Methodological work and applications needed Further promote multidisciplinary culture Further promote multidisciplinary culture Achieve through capacity building Achieve through capacity building

Health Impact Assessment Estimate multiple impacts Influence decisions Influence decisions Identify and involve stakeholders