Addressing Health in SEA for Healthy Public Policy An initial contribution from SEA development in Thailand Suphakij Nuntavorakarn, Nuntana Sabrum, Decharut Sukkumnoed The HPP-HIA Program, Health Systems Research Institute

The ground of SEA development  The National Health System Reform, since 2000  Health: physical, mental, social, and spiritual well-being of the people  Healthy Public Policy (HPP) become the goal and means of the reform

The ground of SEA development  Develop Health Impact Assessment for Healthy Public Policy, since 2001  HPP: Healthy public policy process to achieve the ‘well-being’ in all four aspects of health; physical, mental, social, and spiritual

Necessities of SEA  Centralized policy and planning process  Strategic decisions with no public participation  Many conflicts at project level  EIA has limited role to play  Power inequalities in the society: Info., Knowledge, Institution, Political

Necessities of SEA  Health Impact Assessment: success (or progress) in some aspects, but inadequately deal with strategic issues and alternatives  Applying SEA for Healthy Public Policy

The evolution of SEA  SEA has been perceived and evolved differently in Thai society  SEA needs to evolve according to the context of Thai society Policy process Good Governance Civil society

The four SEA approaches in Thai society  SEA EIA School  SEA Area Base  SEA Policy Options  SEA Development Directions

Various SEA approaches : Differences and connections  To facilitate the evolution of SEA in Thai society  Not answer ‘which one is the best?’  But rather for better applying, linkages, and also the analysis of addressing health in SEA

Main characteristic Analysis of context, value, factors, problems, and opportunities to synthesize the best strategic direction/option SEA Development Directions Analysis of impacts and trade-off of various policy options SEA Policy Options Analysis on different aspects of an area to provide the scope, limitations, and potentials for development SEA Area Base Impact analysis of dev. direction, program, (or mega-project), usually predetermined by powerful actors already SEA-EIA

Core research question What is the best strategic direction/option, according to the context, value, factors, problems and opportunities of the issue? SEA Development Directions What are the policy options and comparison of the impacts, and the trade- off in each option? SEA Policy Options What are the factors, conditions and opportunity of an area that should be concerned for development? SEA Area Base What are the significant environmental impacts and what are the mitigation measures? SEA-EIA

Zero alternative Action on the same directionSEA Development Directions Action on the same optionSEA Policy Options No action to the areaSEA Area Base No action as determined or plannedSEA-EIA

Expected outcomes Development direction and policy that is appropriate to social and envi. context and factors SEA Development Directions Deliberative decision-making process of the society on various policy options SEA Policy Options Development, project dev. and site selection that are appropriate to the context of the area SEA Area Base Minimize envi. impacts with mitigation measures SEA-EIA

Main limitations Long process, long time Not for (seriously) conflicting issues SEA Development Directions No details of area-base context&factors No comprehensive alternative dev. SEA Policy Options Limitations of Area-base approach in the policy process SEA Area Base For approval/permit, Not changing strategic directions SEA-EIA

The health concepts  EIA approach to health Main focus on envi. impacts Health as the consequences of envi. impacts  Ecosystem approach to health Environment as an Ecosystem comprises of biophysical, social, and economic environment Human health = Ecosystem health Health as a main component in the Ecosystem

The health concepts  Healthy Public Policy approach All aspects effect health Any public policy: incorporate health consideration, promote healthy policy alternatives, and ‘Healthy’ policy process Health as comprehensive impacts and integrated assessment

The health concepts  Health inequalities approach Health is not only the matter of individual Social factors that determine individual health risks and opportunities ‘Cause of the Causes’ or Social Determinants of Health Health as a way of living healthy together

Addressing health in the four SEA approaches Health Inequalities Healthy Public Policy Ecosystem Approach EIA Approach SEA Dev. Direction SEA Policy Options SEA Area Base SEA EIA School Need Intention Outside Factors Should Not Should Improve

Applying and Linking  Examples of ideas that we are working on  Power policy We are working on SEA Policy Options (HPP approach) But after this, should do SEA Area Base  Water crisis in the Eastern Region Initiating SEA Policy Options (Tend to be HPP approach) But actually, may need to do SEA Development Directions later

Applying and Linking  Salt resources management in the Northeastern Region: Synthesizing fragmented problems and the totally new strategic issue emerged Initiating SEA Development Directions (May be the Ecosystem approach) But may need SEA Policy Options in the next step or near future  Initial mapping of addressing health for strategic issues, to be developed further

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