Health impact assessment and health promotion.
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Health Promotion↗
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Health impact of worksite health promotion programs.
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Health Promotion↗
The potential impacts of climate variability and change on health impacts of extreme weather events in the United States.
Extreme weather events such as precipitation extremes and severe storms cause hundreds of deaths and injuries annually in the United States. Climate change may alter the frequency, timing, intensity, and duration of these events. Increases in heavy precipitation have occurred over the past century. Future climate scenarios show likely increases in the frequency of extreme precipitation events, including precipitation during hurricanes, raising the risk of floods. Frequencies of tornadoes and hurricanes cannot reliably be projected. Injury and death are the direct health impacts most often associated with natural disasters. Secondary effects, mediated by changes in ecologic systems and public health infrastructure, also occur. The health impacts of extreme weather events hinge on the vulnerabilities and recovery capacities of the natural environment and the local population. Relevant variables include building codes, warning systems, disaster policies, evacuation plans, and relief efforts. There are many federal, state, and local government agencies and nongovernmental organizations involved in planning for and responding to natural disasters in the United States. Future research on health impacts of extreme weather events should focus on improving climate models to project any trends in regional extreme events and as a result improve public health preparedness and mitigation. Epidemiologic studies of health effects beyond the direct impacts of disaster will provide a more accurate measure of the full health impacts and will assist in planning and resource allocation.
Climate↗
Health impact assessment in New Zealand.
Health impact assessment (HIA) has its origins in environmental impact assessment methodology. New Zealand's approach to health impact assessment is consistent with other countries. During the 1990s, legislation that related to the management of natural and physical resources provided the basis for public health engagement in impact assessment. In the mid 1990s, the Public Health Commission released guidelines on health impact assessment that adopted a risk assessment approach and was aimed at particular environmental projects. The transition to policy-level impact assessment occurred in 2000 with the national health strategy identifying impact assessment as one its key objectives. Guidelines developed by the Public Health Advisory Committee in 2004 have been applied in a small number of policy-level health impact assessments in New Zealand. One of these projects was the review of a Liveable Communities Plan, a policy proposal for town centre growth and development.
Environmental Illness↗
A prospective health impact assessment of the Merseyside Integrated Transport Strategy (MerITS).
BACKGROUND: Prospective health impact assessment is a new approach to predicting potential health impacts of policies, programmes or projects. It has been widely recognized that public policies have important impacts on health. In 1997, the Liverpool Public Health Observatory was commissioned to carry out a health impact assessment of the Merseyside Integrated Transport Strategy (MerITS). A secondary aim was to pilot a method for health impact assessment at the strategic level. METHODS: The methods used drew on previous health impact assessments of projects, on strategic environmental assessment, and on policy research. They included policy analysis, semi-structured interviews with key informants and literature searches. RESULTS: Four priority impact areas of MerITS were identified: establishing road hierarchies, economic viability, air quality, and public transport. Potential health impacts in each of these areas were estimated, and recommendations were made to minimize the effects of negative impacts and to enhance positive ones. CONCLUSION: This health impact assessment prospectively identified the key health impacts of a strategy on a defined population and made recommendations to maximize potential positive and minimize potential negative health impacts. The methods employed are generally applicable to prospective health impact assessments of public policies and strategies.
Accidents, Traffic↗
Prospects for health impact assessment in the United States: new and improved environmental impact assessment or something different?
Health impact assessment (HIA) has been advanced as a means of bringing potential health impacts to the attention of policy makers, particularly in sectors where health impacts may not otherwise be considered. This article examines lessons for HIA in the United States from the related and relatively well-developed field of environmental impact assessment (EIA). We reviewed the EIA literature and conducted twenty phone interviews with EIA professionals. Successes of EIA cited by respondents included integration of environmental goals into decision making, improved planning, and greater transparency and public involvement. Reported shortcomings included the length and complexity of EIA documents, limited and adversarial public participation, and an emphasis on procedure over substance. Presently, EIAs consider few, if any, health outcomes. Respondents differed on the prospects for HIA. Most agreed that HIA could contribute to EIA in several areas, including assessment of cumulative impacts and impacts to environmental justice. Reasons given for not incorporating HIA into EIA were uncertainties about interpreting estimated health impacts, that EIA documents would become even longer and more complicated, and that HIA would gain little from the procedural and legal emphasis in EIA. We conclude that for HIA to advance, whether as part of or separate from EIA, well-formulated methodologies need to be developed and tested in real-world situations. When possible, HIA should build on the methods that have been utilized successfully in EIA. The most fruitful avenue is demonstration projects that test, refine, and demonstrate different methods and models to maximize their utility and acceptance.
California↗
The health impact of smoking in manual and non-manual social class men and women: a test of the Blaxter hypothesis.
Blaxter has hypothesized that harmful behavioral habits like smoking have a greater impact on health in the non-manual than in the manual social classes, possibly because other adverse exposures have a more important role in the manual social classes. However, the outcome measure used was a composite measure of physiological indices of morbidity and the relevance of this to other health problems is uncertain. We have therefore investigated the effect of smoking on mortality, to test whether the risk of death associated with smoking differs between manual and non-manual social classes. Data on 6831 men and 7993 women, aged 45-64 when screened in the Renfrew and Paisley study, a large prospective observational study in the West of Scotland, have been analyzed. All cause mortality rate ratios for smokers compared with never smokers have been calculated within manual and non-manual social classes. Although the age adjusted rate ratios are slightly higher among the non-manual men and women (2.19 [1.83-2.61] versus 1.92 [1.71-2.17] for non-manual and manual men respectively, and 1.75 [1.54-1.99] versus 1.65 [1.50-1.82] for non-manual and manual women), this difference between social classes is not statistically significant (p-values for test of difference 0.26 and 0.47 for men and women respectively). When additionally adjusted for other risk factors, cardiorespiratory symptoms and deprivation, this picture remained the same (p-values for test of difference are 0.41 and 0.50 for men and women respectively). Similar results were found when the cohort was divided by deprivation categories rather than social classes or when smoking related mortality rather than mortality from all causes was used as the outcome measure. We therefore conclude that the health impact of smoking is similar in each socio-economic group. The relative health improvement consequent on smoking cessation is thus similar in different socio-economic groups.
Aged↗
Migration and health impact assessment.
Government policies, programmes and projects can have a significant impact on health. Health impact assessments (HIAs) seek to estimate this impact, but they often do so by measuring intermediate or proxy indicators and factors that act to determine health. These measures frequently assume a static population. However, regeneration policies can work hard for several years to no apparent effect. One explanation could be migration. Families who have benefited move from the area and other, perhaps more deprived, families move in. Conversely, healthy, prosperous families may move into an improved area, giving the impression that the health of the population has changed, when in fact it is the actual population that has changed. Census data in England and Wales show that a positive correlation exists between migration within wards and deprivation scores. This paper explores the possible implications of migration for HIA. The census, NHS central register, electoral register, labour force survey, central index of the Department of Social Security, council tax database and other data sources are examined to identify what migration data are available at a local level. Factors that determine rates of migration at a local level have been reviewed, with special reference to the differences between population subgroups. The paper concludes with recommendations to take account of residential mobility and changes in migration patterns when carrying out HIAs.
Adolescent↗
A modified short version of the oral health impact profile for assessing health-related quality of life in edentulous adults.
PURPOSE: The aim of this study was to develop a shortened version of the Oral Health Impact Profile (OHIP) appropriate for use in edentulous patients and to evaluate its measurement properties. MATERIALS AND METHODS: Data were collected from the Ontario Study of Older Adults and a longitudinal clinical trial of implant-retained prostheses undertaken in Newcastle Dental Hospital, UK. All subjects completed an OHIP at baseline, and UK subjects also completed an OHIP posttreatment. Using an item impact reduction method, a shortened version of the OHIP (called OHIP-EDENT) was derived from both datasets. Discriminant validity and responsiveness properties of this modified version were compared with OHIP-14 and OHIP-49. RESULTS: Using an item impact method of reducing the 49 OHIP items produced very similar subsets in both Canadian and British populations; the modified version had little overlap with the current short version (OHIP-14). Discriminant validity properties of OHIP-EDENT were similar to OHIP-14 and OHIP-49. Using effect sizes to assess sensitivity to change, OHIP-EDENT exhibited less susceptibility to floor effects than OHIP-14 and appeared to measure change as effectively as OHIP-49. CONCLUSION: The modified shortened version of the OHIP derived in this study has measurement properties comparable with the full 49-item version. This modified shortened version may be more appropriate for use in edentulous patients than the current short version.
Aged↗
Health impact assessment and the consideration of health inequalities.
Equity and the consideration of the differential impacts of public policy within populations are core values of health impact assessment. A recent paper setting out the results of the government's consultation exercise on tackling health inequalities argues for health impact assessment to be used as a mechanism to bring about reductions in health inequalities. However, we would contend that most, if not all, published health impact assessments have not considered the effects of public policies on health inequalities in a robust or reliable manner. In this paper we set out and explore some of the issues that require consideration if health impact assessment is fulfil the government's expectations.
Health Services Accessibility↗
Implementation of a Health Impact Assessment (HIA) tool in a regional health organization in Sweden--a feasibility study.
During the last decade, Health Impact Assessment (HIA) has been discussed worldwide as being an important tool for the development of healthy public policy. In Sweden, the Swedish Federation of County Councils and the Swedish Association of Local Authorities have taken the initiative to and are responsible for the development of an HIA tool concerning proposed policy decisions at local and regional levels. The HIA tool was developed as three different templates to be adapted to local conditions and needs: the Health Question, the Health Matrix and the Health Impact Analysis. In this paper we present a feasibility study of the experiences of implementing this HIA tool at regional level in a Health Care District (SWHCD) of Stockholm County Council, based on an inductive approach and on principles of data triangulation. The main findings include the need for continuous revision of the HIA templates during the pilot period. The following factors were instrumental in successfully using the HIA tool in local policy making and management: political consensus, agreement between politicians and public officials on political intentions, a clear- cut decision from management, and offering an opportunity for training. Respondents felt that all public officials should use the HIA as part of their normal work routines. In conclusion, the HIA tool has to be locally adapted and the implementation process has to include close collaboration between politicians and public officials and be followed by continuing education, providing possibilities for a dialogue around the HIA tool, in order to ensure the quality of the instrument. Implications of the study are that the process of developing the tool has worked well but that the possible impacts of its use in this case remain an open question. However, this was not the focus of our study.
Feasibility Studies↗
The potential health impacts of climate change: an overview.
Climate change would have a range of impacts on human health. Health impacts would be caused by the direct effect of climatic factors on human health, such as heat stress, and possible changes in the frequency and intensity of extreme weather events such as storms, floods and droughts. Impacts on health would also be mediated by the indirect effects of climate change, such as changes in availability of food and water and the distribution of vector-borne diseases. The majority of health impacts would be adverse and would depend greatly on the vulnerability of populations.
Acclimatization↗
Why and how should we assess occupational health impacts in integrated product policy?
Integrated product policy (IPP) and life cycle assessment (LCA), one of the analytic tools used in IPP, focus traditionally on environmental impacts. However, in an attempt to consider other sustainability criteria and to avoid a shift from environmental health impacts to occupational health impacts one may want to include occupational health in IPP. Should and can occupational health impacts be included in LCA and IPP? Using published and unpublished occupational health data for injuries and illnesses and an economic input-output model of the United States, we provide attributional occupational health impacts measured in disability adjusted life years per dollars output for 491 industry sectors including supply chain impacts. Estimates for the "true" number of United States occupational health impacts suggest that this initial analysis underestimates the total impact 3-7-fold. A comparison suggests that United States occupational health impacts are about 10 times smaller than environmental health impacts and are, relatively speaking, important only for sectors with hazardous working environments but low environmental impacts. A consequential rather than attributional view suggests that a method to assess true consequences on long-term health impacts by product policies needs to be able to predict effects from present-day work place exposure and to account for likely changes in the labor market, including changes in unemployment rates and other substitution mechanisms.
Accidents, Occupational↗
The 'people assessing their health' (PATH) Project: tools for community health impact assessment.
The People Assessing Their Health (PATH) Project was designed to provide a means for people in selected communities within Eastern Nova Scotia to become more involved in decision making within the province's emerging decentralized health system. Using community health impact assessment (CHIA) as a population health strategy, community members were able to identify factors that determine their health and to develop tools to help them assess the health impact of programs and policies within their communities. The participatory process used throughout the PATH Project enabled a wide range of people to generate information for designing a community health impact assessment tool (CHIAT) unique to their community. It also helped participants to broaden their understanding of the many factors determining health of their community and of the region.
Community Participation↗
Health impact assessment: assessing opportunities and barriers to intersectoral health improvement in an expanded European Union.
On 1 May 2004 the European Union (EU) underwent unprecedented enlargement, from 15 to 25 countries, increasing its population by 20% to over 450 million. Although EU law has limited specific competence in the area of health, its influence on other policy sectors such as agriculture, trade, and employment has wide ranging implications for health. Yet with the exception of provisions on communicable disease control and food safety, public health considerations have played little part in negotiations on EU accession. This paper argues for an intersectoral public health approach in the expanded EU. It reviews the legal basis for assessing the health impacts of policy in the EU and, using health impact assessment as a case study, it examines how well the new member states may be prepared to tackle intersectoral public health action within the constraints imposed by EU policy.
European Union↗
Health Impact Assessment: how the Canton of Ticino makes health a common issue.
HIA is based on the theory of health determinants, which recognizes that well-being is determined by a wide range of economic, social and environmental factors, by heredity and medical intervention. The intended HIA procedure represents a new approach to the evaluation of all cantonal policies in order to assess their potential health impacts and to improve the quality of governmental decisions, through recommendations to enhance predicted positive health impacts and minimize negative ones.
Environment↗
Promoting social responsibility for health: health impact assessment and healthy public policy at the community level.
The 1997 Jakarta Declaration on Health Promotion into the 21st Century called for new responses to address the emerging threats to health. The declaration placed a high priority on promoting social responsibility for health, and it identified equity-focused health impact assessment as a high priority for action. This theme was among the foci at the 2000 Fifth Global Conference on Health Promotion held in Mexico. This paper, which is an abbreviation of a technical report prepared for the Mexico conference, advances arguments for focusing on health impact assessment at the local level. Health impact assessment identifies negative health impacts that call for policy responses, and identifies and encourages practices and policies that promote health. Health impact assessment may be highly technical and require sophisticated technology and expertise. But it can also be a simple, highly practical process, accessible to ordinary people, and one that helps a community come to grips with local circumstances that need changing for better health. To illustrate the possibilities, this paper presents a case study, the People Assessing Their Health (PATH) project from Eastern Nova Scotia, Canada. It places ordinary citizens, rather than community elites, at the very heart of local decision-making. Evidence from PATH demonstrates that low technology health impact assessment, done by and for local people, can shift thinking beyond the illness problems of individuals. It can bring into consideration, instead, how programmes and policies support or weaken community health, and illuminate a community's capacity to improve local circumstances for better health. This stands in contrast to evidence that highly technological approaches to community-level health impact assessment can be self-defeating. Further development of simple, people-centred, low technology approaches to health impact assessment at the local level is called for.
Community Participation↗
Comparative assessment of transport risks--how it can contribute to health impact assessment of transport policies.
Health impact assessment (HIA) and comparative risk assessment (CRA) are important tools with which governments and communities can compare and integrate different sources of information about various health impacts into a single framework for policy-makers and planners. Both tools have strengths that may be combined usefully when conducting comprehensive assessments of decisions that affect complex health issues, such as the health risks and impacts of transport policy and planning activities. As yet, however, HIA and CRA have not been applied widely to the area of transport. We draw on the limited experience of the application of these tools in the context of road transport to explore how comparative assessment of transport risks can contribute to HIA of transport policies.
Environmental Health↗