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Screw the environment, what about our health? - Health Impact assessment: a tool to help you to make an informed decision.
Screw the environment is a comment likely the have every environmentalist and “Greeny” hopping mad and on the war path. That is not what this article wants to achieve. The aim of this article is to bring to the attention of everyone that we must consider health in its widest context and the implications it has on a project, policy or programme. Health and the *environment must be considered together when assessing a project, policy or programme and not just at the impact it has on the environment. A Health Impact Assessment (HIA) is a tool that helps to do just this. A Health Impact Assessment is not meant to replace an Environmental Impact Assessment (EIA), but to augment it. It is not an “either / or”, but a tool to be used together with an Environmental Impact Assessment. A HIA is prospective by nature, in other words it looks at the likelihood of something occurring in the future as a result of an* action taken now e.g. implementing a new programme or project like FRACKING. What is a HIA? A Health Impact Assessment is generally defined as a “combination of procedures, methods and tools by which a policy, programme or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population.” The World Health Organisation (WHO) defines Health Impact Assessment (HIA) as “a means of assessing the health impacts of policies, plans and projects in diverse economic sectors using quantitative, qualitative and participatory techniques. WHO states that HIA helps decision-makers make choices about alternatives and improvements to prevent disease/injury and to actively promote health. WHO supports tools and initiatives in HIA to dynamically improve health and well-being across sectors.” (http://www.who.int/hia/en/). An HIA is practical and evidence based. Another explanation of HIA is given by the International Health Impact Assessment Consortium at the University of Liverpool (IMPACT): HIA is concerned with improving health and reducing health inequalities. It is a systematic process, which aims to identify what the health effects of a new policy, strategy or project proposal might be on a particular group of people. HIA can be done at a national, regional, city or even ward level. It considers which key health determinants will be affected by the proposals and how these will in turn impact on the health and wellbeing of the population under consideration. By providing evidence to policy makers on the potential health effects of these proposals, it helps to inform their decisions. (http://www.liv.ac.uk/media/livacuk/instituteofpsychology/docs/300412%20LCH%20HIA%20Exec%20Summary%20only.pdf). Figure 1. Model of Health A model of health accepted by practitioners carrying out a HIA is the Dehigren and Whitehead model (Figure 1 and 2). These models *give a broad spectrum view of health and includes the social, economic and community aspects associated with health. Figure 2 is an expanded model of health determinants and indicates the macro factors to be considered. Health impact assessments have been carried out throughout the world and have gained acceptance by governments and large financial institutions like the World Bank and European Union. In the United Kingdom and America it is widely used and accepted as a tool that aids decision making. An HIA is not a replacement for an EIA, but augments and can help in making an informed decision regarding the acceptability of a project and providing possible remedial measures needed to be taken to protect the health of the population. An HIA gives a balanced view, listing both the pros and cons of a project, policy or programme. Health and the environment go hand in hand. A project that harms the environment will have an effect on the health of the population in that environment. A HIA like an EIA is normally carried out by a team from various disciplines. The end result of *a HIA is a balance report giving recommendations that enhance the health benefits of the project, programme or project and mitigate potential negative effects. The strength of a HIA is derived from *it’s unique combination of three essential attributes: · a broad societal perceptive on the determinants of health · significant community consultation and input · the potential to identify and mitigate impacts before they affect local populations (http://www.ph.ucla.edu/hs/health-impact/whatishia.htm [Habitat health impact consulting]
Health determinants A health determinant is simply a factor that has an effect on the health of a person or community. Many factors affect the health of an individual or community. The WHO indicates that factors like the place where you live, the state of the environment, genetics, or economic status, education and our social status and interactions have a considerable influence on health. WHO further states that the determinants of health include: · The social and economic environment · The physical environment, and · The person’s individual characteristics and behaviour The WHO mentions a number of determinants that should be considered when examining a project, programme or policy namely: · transport · food and agriculture · housing · waste · energy · industry · urbanisation · income and social status · physical environment · health services · radiation · macro environment · nutrition and health · education and many more factors
Figure 2. Determinants of health – macro level
An EIA will also look at some of these factors, but not from only a health point of view. The International Association for Impact Assessment (IAIA) defines an environmental impact assessment as "the process of identifying, predicting, evaluating and mitigating the biophysical, social, and other relevant effects of development proposals prior to major decisions being taken and commitments made."[1] EIA*’ s are unique in that they do not require adherence to a predetermined environmental outcome, but rather they require decision makers to account for environmental values in their decisions and to justify those decisions in light of detailed environmental studies and public comments on the potential environmental impacts of the proposal (http://en.wikipedia.org/wiki/Environmental_impact_assessment). From this explanation of what an EIA is you can see that there is a distinct similarity between an EIA and a HIA*, *the difference being that* a HIA is primarily interested in the health aspect of the project or programme while the EIA focuses on the environmental aspects. Both use similar methods and both are supposed to include community and *the stakeholder in their processes. However the HIA normally involves the stakeholders at the beginning of the process. The HIA team is made up of professionals, members of the community and stakeholders. The principals are also often directly involved in the process. Following from this comes the question “what is the process or methodology?” The answer is not that simple because the methods of carrying out an HIA are still being refined and draw on the methodology of other disciplines. A HIA generally follows a similar process as an EIA. The Model described by Winters and Scott-Samuel (1997) indicates the following stages: 1. Application of screening criteria (to select policy, programme or project) 2. Profiling the affected areas / communities using demographic data from key informants 3. Identification of key informants which includes community participation 4. Identification of health impacts by project stage and category of health influence 5. Assessment of measurability and certainty of impacts 6. Selection of highest priority impact areas 7. Identification of further research needs and information needs 8. Consideration of alternative options 9. Recommendations for management of priority impacts (Winters L, Scott-Samuel A. Health Impact Assessment of the Community Safety Projects. Huyton SRB Area. Observatory Report Series #38 1997)
This model is not the only model used, but it highlights the most important phases of a HIA. Health impact assessments are not new, but it is still evolving as more academics embrace the process and refine its methodologies. Like an EIA, screening is the first step. Screening The purpose of screening is *to assess the suitability of HIA and to decide whether or not to proceed with the HIA. It is a sifting process which leads either to the next step in the process, namely scoping or *(?)terminating. Screening results in a brief assessment on whether a HIA is feasible and of value. A steering group is often established during this phase should the project be deemed to warrant a HIA. The steering committee then determines the terms of reference for the assessment. The steering group is multi disciplinary by nature and includes key informants, project proponents, representatives of the major stakeholders and health experts. It is also during this phase that the extent of the HIA is determined; will a comprehensive HIA be carried out or a minor/rapid HIA. Scoping Scoping is the process of defining the how, what, who and when of the HIA. It is the outline of the impact analysis including the data on the relevant baseline characteristics of the target population. In this phase the assessment model and tools are decided on, the policies and legislation applicable and what evidence is available to profile the assessment population. The reporting procedures are also set out in this phase. Hereafter the assessment is carried out. The stakeholders and affected persons (community) are kept informed throughout the assessment process. Their input is incorporated into the assessment. The assessors then carry out the assessment according to the approved Terms of reference. The relevant reports are drafted and presented to the proponents and stakeholders for acceptance and finalised for incorporation in an EIA or given to the commissioners of the HIA.
Who should commission a HIA? HIA is a tool that can be used by both governments and organisations to help them make informed decisions. Companies can use it when proposing new policies and projects. Mining companies should use HIA when expanding their activities, starting new mines and planning the closure of mines. Road agencies should commission a HIA when planning new roads. Property developers planning a new development or planning a new township should use a HIA before they commit to a project. The World Bank and large financial institutions are now starting to require an HIA before approving loans. Government should use HIA before approving any policy, programme or project. Governments throughout the world are starting to recognise the benefits of using HIA, some have even made it obligatory. Finally, every EIA should include a HIA Screw the environment, what about our health? - Health Impact assessment:* a tool to help you to make an informed decision.
Screw the environment is a comment likely the have every environmentalist and “Greeny” hopping mad and on the war path. That is not what this article wants to achieve. The aim of this article is to bring to the attention of everyone that we must consider health in its widest context and the implications it has on a project, policy or programme. Health and the *environment must be considered together when assessing a project, policy or programme and not just at the impact it has on the environment. A Health Impact Assessment (HIA) is a tool that helps to do just this. A Health Impact Assessment is not meant to replace an Environmental Impact Assessment (EIA), but to augment it. It is not an “either / or”, but a tool to be used together with an Environmental Impact Assessment. A HIA is prospective by nature, in other words it looks at the likelihood of something occurring in the future as a result of an* action taken now e.g. implementing a new programme or project like FRACKING. What is a HIA? A Health Impact Assessment is generally defined as a “combination of procedures, methods and tools by which a policy, programme or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population.” The World Health Organisation (WHO) defines Health Impact Assessment (HIA) as “a means of assessing the health impacts of policies, plans and projects in diverse economic sectors using quantitative, qualitative and participatory techniques. WHO states that HIA helps decision-makers make choices about alternatives and improvements to prevent disease/injury and to actively promote health. WHO supports tools and initiatives in HIA to dynamically improve health and well-being across sectors.” (http://www.who.int/hia/en/). An HIA is practical and evidence based. Another explanation of HIA is given by the International Health Impact Assessment Consortium at the University of Liverpool (IMPACT): HIA is concerned with improving health and reducing health inequalities. It is a systematic process, which aims to identify what the health effects of a new policy, strategy or project proposal might be on a particular group of people. HIA can be done at a national, regional, city or even ward level. It considers which key health determinants will be affected by the proposals and how these will in turn impact on the health and wellbeing of the population under consideration. By providing evidence to policy makers on the potential health effects of these proposals, it helps to inform their decisions. (http://www.liv.ac.uk/media/livacuk/instituteofpsychology/docs/300412%20LCH%20HIA%20Exec%20Summary%20only.pdf). Figure 1. Model of Health A model of health accepted by practitioners carrying out a HIA is the Dehigren and Whitehead model (Figure 1 and 2). These models *give a broad spectrum view of health and includes the social, economic and community aspects associated with health. Figure 2 is an expanded model of health determinants and indicates the macro factors to be considered. Health impact assessments have been carried out throughout the world and have gained acceptance by governments and large financial institutions like the World Bank and European Union. In the United Kingdom and America it is widely used and accepted as a tool that aids decision making. An HIA is not a replacement for an EIA, but augments and can help in making an informed decision regarding the acceptability of a project and providing possible remedial measures needed to be taken to protect the health of the population. An HIA gives a balanced view, listing both the pros and cons of a project, policy or programme. Health and the environment go hand in hand. A project that harms the environment will have an effect on the health of the population in that environment. A HIA like an EIA is normally carried out by a team from various disciplines. The end result of *a HIA is a balance report giving recommendations that enhance the health benefits of the project, programme or project and mitigate potential negative effects. The strength of a HIA is derived from *it’s unique combination of three essential attributes: · a broad societal perceptive on the determinants of health · significant community consultation and input · the potential to identify and mitigate impacts before they affect local populations (http://www.ph.ucla.edu/hs/health-impact/whatishia.htm [Habitat health impact consulting]
Health determinants A health determinant is simply a factor that has an effect on the health of a person or community. Many factors affect the health of an individual or community. The WHO indicates that factors like the place where you live, the state of the environment, genetics, or economic status, education and our social status and interactions have a considerable influence on health. WHO further states that the determinants of health include: · The social and economic environment · The physical environment, and · The person’s individual characteristics and behaviour The WHO mentions a number of determinants that should be considered when examining a project, programme or policy namely: · transport · food and agriculture · housing · waste · energy · industry · urbanisation · income and social status · physical environment · health services · radiation · macro environment · nutrition and health · education and many more factors
Figure 2. Determinants of health – macro level
An EIA will also look at some of these factors, but not from only a health point of view. The International Association for Impact Assessment (IAIA) defines an environmental impact assessment as "the process of identifying, predicting, evaluating and mitigating the biophysical, social, and other relevant effects of development proposals prior to major decisions being taken and commitments made."[1] EIA*’ s are unique in that they do not require adherence to a predetermined environmental outcome, but rather they require decision makers to account for environmental values in their decisions and to justify those decisions in light of detailed environmental studies and public comments on the potential environmental impacts of the proposal (http://en.wikipedia.org/wiki/Environmental_impact_assessment). From this explanation of what an EIA is you can see that there is a distinct similarity between an EIA and a HIA*, *the difference being that* a HIA is primarily interested in the health aspect of the project or programme while the EIA focuses on the environmental aspects. Both use similar methods and both are supposed to include community and *the stakeholder in their processes. However the HIA normally involves the stakeholders at the beginning of the process. The HIA team is made up of professionals, members of the community and stakeholders. The principals are also often directly involved in the process. Following from this comes the question “what is the process or methodology?” The answer is not that simple because the methods of carrying out an HIA are still being refined and draw on the methodology of other disciplines. A HIA generally follows a similar process as an EIA. The Model described by Winters and Scott-Samuel (1997) indicates the following stages: 1. Application of screening criteria (to select policy, programme or project) 2. Profiling the affected areas / communities using demographic data from key informants 3. Identification of key informants which includes community participation 4. Identification of health impacts by project stage and category of health influence 5. Assessment of measurability and certainty of impacts 6. Selection of highest priority impact areas 7. Identification of further research needs and information needs 8. Consideration of alternative options 9. Recommendations for management of priority impacts (Winters L, Scott-Samuel A. Health Impact Assessment of the Community Safety Projects. Huyton SRB Area. Observatory Report Series #38 1997)
This model is not the only model used, but it highlights the most important phases of a HIA. Health impact assessments are not new, but it is still evolving as more academics embrace the process and refine its methodologies. Like an EIA, screening is the first step. Screening The purpose of screening is *to assess the suitability of HIA and to decide whether or not to proceed with the HIA. It is a sifting process which leads either to the next step in the process, namely scoping or *(?)terminating. Screening results in a brief assessment on whether a HIA is feasible and of value. A steering group is often established during this phase should the project be deemed to warrant a HIA. The steering committee then determines the terms of reference for the assessment. The steering group is multi disciplinary by nature and includes key informants, project proponents, representatives of the major stakeholders and health experts. It is also during this phase that the extent of the HIA is determined; will a comprehensive HIA be carried out or a minor/rapid HIA. Scoping Scoping is the process of defining the how, what, who and when of the HIA. It is the outline of the impact analysis including the data on the relevant baseline characteristics of the target population. In this phase the assessment model and tools are decided on, the policies and legislation applicable and what evidence is available to profile the assessment population. The reporting procedures are also set out in this phase. Hereafter the assessment is carried out. The stakeholders and affected persons (community) are kept informed throughout the assessment process. Their input is incorporated into the assessment. The assessors then carry out the assessment according to the approved Terms of reference. The relevant reports are drafted and presented to the proponents and stakeholders for acceptance and finalised for incorporation in an EIA or given to the commissioners of the HIA.
Who should commission a HIA? HIA is a tool that can be used by both governments and organisations to help them make informed decisions. Companies can use it when proposing new policies and projects. Mining companies should use HIA when expanding their activities, starting new mines and planning the closure of mines. Road agencies should commission a HIA when planning new roads. Property developers planning a new development or planning a new township should use a HIA before they commit to a project. The World Bank and large financial institutions are now starting to require an HIA before approving loans. Government should use HIA before approving any policy, programme or project. Governments throughout the world are starting to recognise the benefits of using HIA, some have even made it obligatory. Finally, every EIA should include a HIA Screw the environment, what about our health? - Health Impact assessment:* a tool to help you to make an informed decision.
Screw the environment is a comment likely the have every environmentalist and “Greeny” hopping mad and on the war path. That is not what this article wants to achieve. The aim of this article is to bring to the attention of everyone that we must consider health in its widest context and the implications it has on a project, policy or programme. Health and the *environment must be considered together when assessing a project, policy or programme and not just at the impact it has on the environment. A Health Impact Assessment (HIA) is a tool that helps to do just this. A Health Impact Assessment is not meant to replace an Environmental Impact Assessment (EIA), but to augment it. It is not an “either / or”, but a tool to be used together with an Environmental Impact Assessment. A HIA is prospective by nature, in other words it looks at the likelihood of something occurring in the future as a result of an* action taken now e.g. implementing a new programme or project like FRACKING. What is a HIA? A Health Impact Assessment is generally defined as a “combination of procedures, methods and tools by which a policy, programme or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population.” The World Health Organisation (WHO) defines Health Impact Assessment (HIA) as “a means of assessing the health impacts of policies, plans and projects in diverse economic sectors using quantitative, qualitative and participatory techniques. WHO states that HIA helps decision-makers make choices about alternatives and improvements to prevent disease/injury and to actively promote health. WHO supports tools and initiatives in HIA to dynamically improve health and well-being across sectors.” (http://www.who.int/hia/en/). An HIA is practical and evidence based. Another explanation of HIA is given by the International Health Impact Assessment Consortium at the University of Liverpool (IMPACT): HIA is concerned with improving health and reducing health inequalities. It is a systematic process, which aims to identify what the health effects of a new policy, strategy or project proposal might be on a particular group of people. HIA can be done at a national, regional, city or even ward level. It considers which key health determinants will be affected by the proposals and how these will in turn impact on the health and wellbeing of the population under consideration. By providing evidence to policy makers on the potential health effects of these proposals, it helps to inform their decisions. (http://www.liv.ac.uk/media/livacuk/instituteofpsychology/docs/300412%20LCH%20HIA%20Exec%20Summary%20only.pdf). Figure 1. Model of Health A model of health accepted by practitioners carrying out a HIA is the Dehigren and Whitehead model (Figure 1 and 2). These models *give a broad spectrum view of health and includes the social, economic and community aspects associated with health. Figure 2 is an expanded model of health determinants and indicates the macro factors to be considered. Health impact assessments have been carried out throughout the world and have gained acceptance by governments and large financial institutions like the World Bank and European Union. In the United Kingdom and America it is widely used and accepted as a tool that aids decision making. An HIA is not a replacement for an EIA, but augments and can help in making an informed decision regarding the acceptability of a project and providing possible remedial measures needed to be taken to protect the health of the population. An HIA gives a balanced view, listing both the pros and cons of a project, policy or programme. Health and the environment go hand in hand. A project that harms the environment will have an effect on the health of the population in that environment. A HIA like an EIA is normally carried out by a team from various disciplines. The end result of *a HIA is a balance report giving recommendations that enhance the health benefits of the project, programme or project and mitigate potential negative effects. The strength of a HIA is derived from *it’s unique combination of three essential attributes: · a broad societal perceptive on the determinants of health · significant community consultation and input · the potential to identify and mitigate impacts before they affect local populations (http://www.ph.ucla.edu/hs/health-impact/whatishia.htm [Habitat health impact consulting]
Health determinants A health determinant is simply a factor that has an effect on the health of a person or community. Many factors affect the health of an individual or community. The WHO indicates that factors like the place where you live, the state of the environment, genetics, or economic status, education and our social status and interactions have a considerable influence on health. WHO further states that the determinants of health include: · The social and economic environment · The physical environment, and · The person’s individual characteristics and behaviour The WHO mentions a number of determinants that should be considered when examining a project, programme or policy namely: · transport · food and agriculture · housing · waste · energy · industry · urbanisation · income and social status · physical environment · health services · radiation · macro environment · nutrition and health · education and many more factors
Figure 2. Determinants of health – macro level
An EIA will also look at some of these factors, but not from only a health point of view. The International Association for Impact Assessment (IAIA) defines an environmental impact assessment as "the process of identifying, predicting, evaluating and mitigating the biophysical, social, and other relevant effects of development proposals prior to major decisions being taken and commitments made."[1] EIA*’ s are unique in that they do not require adherence to a predetermined environmental outcome, but rather they require decision makers to account for environmental values in their decisions and to justify those decisions in light of detailed environmental studies and public comments on the potential environmental impacts of the proposal (http://en.wikipedia.org/wiki/Environmental_impact_assessment). From this explanation of what an EIA is you can see that there is a distinct similarity between an EIA and a HIA*, *the difference being that* a HIA is primarily interested in the health aspect of the project or programme while the EIA focuses on the environmental aspects. Both use similar methods and both are supposed to include community and *the stakeholder in their processes. However the HIA normally involves the stakeholders at the beginning of the process. The HIA team is made up of professionals, members of the community and stakeholders. The principals are also often directly involved in the process. Following from this comes the question “what is the process or methodology?” The answer is not that simple because the methods of carrying out an HIA are still being refined and draw on the methodology of other disciplines. A HIA generally follows a similar process as an EIA. The Model described by Winters and Scott-Samuel (1997) indicates the following stages: 1. Application of screening criteria (to select policy, programme or project) 2. Profiling the affected areas / communities using demographic data from key informants 3. Identification of key informants which includes community participation 4. Identification of health impacts by project stage and category of health influence 5. Assessment of measurability and certainty of impacts 6. Selection of highest priority impact areas 7. Identification of further research needs and information needs 8. Consideration of alternative options 9. Recommendations for management of priority impacts (Winters L, Scott-Samuel A. Health Impact Assessment of the Community Safety Projects. Huyton SRB Area. Observatory Report Series #38 1997)
This model is not the only model used, but it highlights the most important phases of a HIA. Health impact assessments are not new, but it is still evolving as more academics embrace the process and refine its methodologies. Like an EIA, screening is the first step. Screening The purpose of screening is *to assess the suitability of HIA and to decide whether or not to proceed with the HIA. It is a sifting process which leads either to the next step in the process, namely scoping or *(?)terminating. Screening results in a brief assessment on whether a HIA is feasible and of value. A steering group is often established during this phase should the project be deemed to warrant a HIA. The steering committee then determines the terms of reference for the assessment. The steering group is multi disciplinary by nature and includes key informants, project proponents, representatives of the major stakeholders and health experts. It is also during this phase that the extent of the HIA is determined; will a comprehensive HIA be carried out or a minor/rapid HIA. Scoping Scoping is the process of defining the how, what, who and when of the HIA. It is the outline of the impact analysis including the data on the relevant baseline characteristics of the target population. In this phase the assessment model and tools are decided on, the policies and legislation applicable and what evidence is available to profile the assessment population. The reporting procedures are also set out in this phase. Hereafter the assessment is carried out. The stakeholders and affected persons (community) are kept informed throughout the assessment process. Their input is incorporated into the assessment. The assessors then carry out the assessment according to the approved Terms of reference. The relevant reports are drafted and presented to the proponents and stakeholders for acceptance and finalised for incorporation in an EIA or given to the commissioners of the HIA.
Who should commission a HIA? HIA is a tool that can be used by both governments and organisations to help them make informed decisions. Companies can use it when proposing new policies and projects. Mining companies should use HIA when expanding their activities, starting new mines and planning the closure of mines. Road agencies should commission a HIA when planning new roads. Property developers planning a new development or planning a new township should use a HIA before they commit to a project. The World Bank and large financial institutions are now starting to require an HIA before approving loans. Government should use HIA before approving any policy, programme or project. Governments throughout the world are starting to recognise the benefits of using HIA, some have even made it obligatory. Finally, every EIA should include a HIA Screw the environment, what about our health? - Health Impact assessment:* a tool to help you to make an informed decision.
Screw the environment is a comment likely the have every environmentalist and “Greeny” hopping mad and on the war path. That is not what this article wants to achieve. The aim of this article is to bring to the attention of everyone that we must consider health in its widest context and the implications it has on a project, policy or programme. Health and the *environment must be considered together when assessing a project, policy or programme and not just at the impact it has on the environment. A Health Impact Assessment (HIA) is a tool that helps to do just this. A Health Impact Assessment is not meant to replace an Environmental Impact Assessment (EIA), but to augment it. It is not an “either / or”, but a tool to be used together with an Environmental Impact Assessment. A HIA is prospective by nature, in other words it looks at the likelihood of something occurring in the future as a result of an* action taken now e.g. implementing a new programme or project like FRACKING. What is a HIA? A Health Impact Assessment is generally defined as a “combination of procedures, methods and tools by which a policy, programme or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population.” The World Health Organisation (WHO) defines Health Impact Assessment (HIA) as “a means of assessing the health impacts of policies, plans and projects in diverse economic sectors using quantitative, qualitative and participatory techniques. WHO states that HIA helps decision-makers make choices about alternatives and improvements to prevent disease/injury and to actively promote health. WHO supports tools and initiatives in HIA to dynamically improve health and well-being across sectors.” (http://www.who.int/hia/en/). An HIA is practical and evidence based. Another explanation of HIA is given by the International Health Impact Assessment Consortium at the University of Liverpool (IMPACT): HIA is concerned with improving health and reducing health inequalities. It is a systematic process, which aims to identify what the health effects of a new policy, strategy or project proposal might be on a particular group of people. HIA can be done at a national, regional, city or even ward level. It considers which key health determinants will be affected by the proposals and how these will in turn impact on the health and wellbeing of the population under consideration. By providing evidence to policy makers on the potential health effects of these proposals, it helps to inform their decisions. (http://www.liv.ac.uk/media/livacuk/instituteofpsychology/docs/300412%20LCH%20HIA%20Exec%20Summary%20only.pdf). Figure 1. Model of Health A model of health accepted by practitioners carrying out a HIA is the Dehigren and Whitehead model (Figure 1 and 2). These models *give a broad spectrum view of health and includes the social, economic and community aspects associated with health. Figure 2 is an expanded model of health determinants and indicates the macro factors to be considered. Health impact assessments have been carried out throughout the world and have gained acceptance by governments and large financial institutions like the World Bank and European Union. In the United Kingdom and America it is widely used and accepted as a tool that aids decision making. An HIA is not a replacement for an EIA, but augments and can help in making an informed decision regarding the acceptability of a project and providing possible remedial measures needed to be taken to protect the health of the population. An HIA gives a balanced view, listing both the pros and cons of a project, policy or programme. Health and the environment go hand in hand. A project that harms the environment will have an effect on the health of the population in that environment. A HIA like an EIA is normally carried out by a team from various disciplines. The end result of *a HIA is a balance report giving recommendations that enhance the health benefits of the project, programme or project and mitigate potential negative effects. The strength of a HIA is derived from *it’s unique combination of three essential attributes: · a broad societal perceptive on the determinants of health · significant community consultation and input · the potential to identify and mitigate impacts before they affect local populations (http://www.ph.ucla.edu/hs/health-impact/whatishia.htm [Habitat health impact consulting]
Health determinants A health determinant is simply a factor that has an effect on the health of a person or community. Many factors affect the health of an individual or community. The WHO indicates that factors like the place where you live, the state of the environment, genetics, or economic status, education and our social status and interactions have a considerable influence on health. WHO further states that the determinants of health include: · The social and economic environment · The physical environment, and · The person’s individual characteristics and behaviour The WHO mentions a number of determinants that should be considered when examining a project, programme or policy namely: · transport · food and agriculture · housing · waste · energy · industry · urbanisation · income and social status · physical environment · health services · radiation · macro environment · nutrition and health · education and many more factors
Figure 2. Determinants of health – macro level
An EIA will also look at some of these factors, but not from only a health point of view. The International Association for Impact Assessment (IAIA) defines an environmental impact assessment as "the process of identifying, predicting, evaluating and mitigating the biophysical, social, and other relevant effects of development proposals prior to major decisions being taken and commitments made."[1] EIA*’ s are unique in that they do not require adherence to a predetermined environmental outcome, but rather they require decision makers to account for environmental values in their decisions and to justify those decisions in light of detailed environmental studies and public comments on the potential environmental impacts of the proposal (http://en.wikipedia.org/wiki/Environmental_impact_assessment). From this explanation of what an EIA is you can see that there is a distinct similarity between an EIA and a HIA*, *the difference being that* a HIA is primarily interested in the health aspect of the project or programme while the EIA focuses on the environmental aspects. Both use similar methods and both are supposed to include community and *the stakeholder in their processes. However the HIA normally involves the stakeholders at the beginning of the process. The HIA team is made up of professionals, members of the community and stakeholders. The principals are also often directly involved in the process. Following from this comes the question “what is the process or methodology?” The answer is not that simple because the methods of carrying out an HIA are still being refined and draw on the methodology of other disciplines. A HIA generally follows a similar process as an EIA. The Model described by Winters and Scott-Samuel (1997) indicates the following stages: 1. Application of screening criteria (to select policy, programme or project) 2. Profiling the affected areas / communities using demographic data from key informants 3. Identification of key informants which includes community participation 4. Identification of health impacts by project stage and category of health influence 5. Assessment of measurability and certainty of impacts 6. Selection of highest priority impact areas 7. Identification of further research needs and information needs 8. Consideration of alternative options 9. Recommendations for management of priority impacts (Winters L, Scott-Samuel A. Health Impact Assessment of the Community Safety Projects. Huyton SRB Area. Observatory Report Series #38 1997)
This model is not the only model used, but it highlights the most important phases of a HIA. Health impact assessments are not new, but it is still evolving as more academics embrace the process and refine its methodologies. Like an EIA, screening is the first step. Screening The purpose of screening is *to assess the suitability of HIA and to decide whether or not to proceed with the HIA. It is a sifting process which leads either to the next step in the process, namely scoping or *(?)terminating. Screening results in a brief assessment on whether a HIA is feasible and of value. A steering group is often established during this phase should the project be deemed to warrant a HIA. The steering committee then determines the terms of reference for the assessment. The steering group is multi disciplinary by nature and includes key informants, project proponents, representatives of the major stakeholders and health experts. It is also during this phase that the extent of the HIA is determined; will a comprehensive HIA be carried out or a minor/rapid HIA. Scoping Scoping is the process of defining the how, what, who and when of the HIA. It is the outline of the impact analysis including the data on the relevant baseline characteristics of the target population. In this phase the assessment model and tools are decided on, the policies and legislation applicable and what evidence is available to profile the assessment population. The reporting procedures are also set out in this phase. Hereafter the assessment is carried out. The stakeholders and affected persons (community) are kept informed throughout the assessment process. Their input is incorporated into the assessment. The assessors then carry out the assessment according to the approved Terms of reference. The relevant reports are drafted and presented to the proponents and stakeholders for acceptance and finalised for incorporation in an EIA or given to the commissioners of the HIA.
Who should commission a HIA? HIA is a tool that can be used by both governments and organisations to help them make informed decisions. Companies can use it when proposing new policies and projects. Mining companies should use HIA when expanding their activities, starting new mines and planning the closure of mines. Road agencies should commission a HIA when planning new roads. Property developers planning a new development or planning a new township should use a HIA before they commit to a project. The World Bank and large financial institutions are now starting to require an HIA before approving loans. Government should use HIA before approving any policy, programme or project. Governments throughout the world are starting to recognise the benefits of using HIA, some have even made it obligatory. Finally, every EIA should include a HIA Screw the environment, what about our health? - Health Impact assessment:* a tool to help you to make an informed decision.
Screw the environment is a comment likely the have every environmentalist and “Greeny” hopping mad and on the war path. That is not what this article wants to achieve. The aim of this article is to bring to the attention of everyone that we must consider health in its widest context and the implications it has on a project, policy or programme. Health and the *environment must be considered together when assessing a project, policy or programme and not just at the impact it has on the environment. A Health Impact Assessment (HIA) is a tool that helps to do just this. A Health Impact Assessment is not meant to replace an Environmental Impact Assessment (EIA), but to augment it. It is not an “either / or”, but a tool to be used together with an Environmental Impact Assessment. A HIA is prospective by nature, in other words it looks at the likelihood of something occurring in the future as a result of an* action taken now e.g. implementing a new programme or project like FRACKING. What is a HIA? A Health Impact Assessment is generally defined as a “combination of procedures, methods and tools by which a policy, programme or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population.” The World Health Organisation (WHO) defines Health Impact Assessment (HIA) as “a means of assessing the health impacts of policies, plans and projects in diverse economic sectors using quantitative, qualitative and participatory techniques. WHO states that HIA helps decision-makers make choices about alternatives and improvements to prevent disease/injury and to actively promote health. WHO supports tools and initiatives in HIA to dynamically improve health and well-being across sectors.” (http://www.who.int/hia/en/). An HIA is practical and evidence based. Another explanation of HIA is given by the International Health Impact Assessment Consortium at the University of Liverpool (IMPACT): HIA is concerned with improving health and reducing health inequalities. It is a systematic process, which aims to identify what the health effects of a new policy, strategy or project proposal might be on a particular group of people. HIA can be done at a national, regional, city or even ward level. It considers which key health determinants will be affected by the proposals and how these will in turn impact on the health and wellbeing of the population under consideration. By providing evidence to policy makers on the potential health effects of these proposals, it helps to inform their decisions. (http://www.liv.ac.uk/media/livacuk/instituteofpsychology/docs/300412%20LCH%20HIA%20Exec%20Summary%20only.pdf). Figure 1. Model of Health A model of health accepted by practitioners carrying out a HIA is the Dehigren and Whitehead model (Figure 1 and 2). These models *give a broad spectrum view of health and includes the social, economic and community aspects associated with health. Figure 2 is an expanded model of health determinants and indicates the macro factors to be considered. Health impact assessments have been carried out throughout the world and have gained acceptance by governments and large financial institutions like the World Bank and European Union. In the United Kingdom and America it is widely used and accepted as a tool that aids decision making. An HIA is not a replacement for an EIA, but augments and can help in making an informed decision regarding the acceptability of a project and providing possible remedial measures needed to be taken to protect the health of the population. An HIA gives a balanced view, listing both the pros and cons of a project, policy or programme. Health and the environment go hand in hand. A project that harms the environment will have an effect on the health of the population in that environment. A HIA like an EIA is normally carried out by a team from various disciplines. The end result of *a HIA is a balance report giving recommendations that enhance the health benefits of the project, programme or project and mitigate potential negative effects. The strength of a HIA is derived from *it’s unique combination of three essential attributes: · a broad societal perceptive on the determinants of health · significant community consultation and input · the potential to identify and mitigate impacts before they affect local populations (http://www.ph.ucla.edu/hs/health-impact/whatishia.htm [Habitat health impact consulting]
Health determinants A health determinant is simply a factor that has an effect on the health of a person or community. Many factors affect the health of an individual or community. The WHO indicates that factors like the place where you live, the state of the environment, genetics, or economic status, education and our social status and interactions have a considerable influence on health. WHO further states that the determinants of health include: · The social and economic environment · The physical environment, and · The person’s individual characteristics and behaviour The WHO mentions a number of determinants that should be considered when examining a project, programme or policy namely: · transport · food and agriculture · housing · waste · energy · industry · urbanisation · income and social status · physical environment · health services · radiation · macro environment · nutrition and health · education and many more factors
Figure 2. Determinants of health – macro level
An EIA will also look at some of these factors, but not from only a health point of view. The International Association for Impact Assessment (IAIA) defines an environmental impact assessment as "the process of identifying, predicting, evaluating and mitigating the biophysical, social, and other relevant effects of development proposals prior to major decisions being taken and commitments made."[1] EIA*’ s are unique in that they do not require adherence to a predetermined environmental outcome, but rather they require decision makers to account for environmental values in their decisions and to justify those decisions in light of detailed environmental studies and public comments on the potential environmental impacts of the proposal (http://en.wikipedia.org/wiki/Environmental_impact_assessment). From this explanation of what an EIA is you can see that there is a distinct similarity between an EIA and a HIA*, *the difference being that* a HIA is primarily interested in the health aspect of the project or programme while the EIA focuses on the environmental aspects. Both use similar methods and both are supposed to include community and *the stakeholder in their processes. However the HIA normally involves the stakeholders at the beginning of the process. The HIA team is made up of professionals, members of the community and stakeholders. The principals are also often directly involved in the process. Following from this comes the question “what is the process or methodology?” The answer is not that simple because the methods of carrying out an HIA are still being refined and draw on the methodology of other disciplines. A HIA generally follows a similar process as an EIA. The Model described by Winters and Scott-Samuel (1997) indicates the following stages: 1. Application of screening criteria (to select policy, programme or project) 2. Profiling the affected areas / communities using demographic data from key informants 3. Identification of key informants which includes community participation 4. Identification of health impacts by project stage and category of health influence 5. Assessment of measurability and certainty of impacts 6. Selection of highest priority impact areas 7. Identification of further research needs and information needs 8. Consideration of alternative options 9. Recommendations for management of priority impacts (Winters L, Scott-Samuel A. Health Impact Assessment of the Community Safety Projects. Huyton SRB Area. Observatory Report Series #38 1997)
This model is not the only model used, but it highlights the most important phases of a HIA. Health impact assessments are not new, but it is still evolving as more academics embrace the process and refine its methodologies. Like an EIA, screening is the first step. Screening The purpose of screening is *to assess the suitability of HIA and to decide whether or not to proceed with the HIA. It is a sifting process which leads either to the next step in the process, namely scoping or *(?)terminating. Screening results in a brief assessment on whether a HIA is feasible and of value. A steering group is often established during this phase should the project be deemed to warrant a HIA. The steering committee then determines the terms of reference for the assessment. The steering group is multi disciplinary by nature and includes key informants, project proponents, representatives of the major stakeholders and health experts. It is also during this phase that the extent of the HIA is determined; will a comprehensive HIA be carried out or a minor/rapid HIA. Scoping Scoping is the process of defining the how, what, who and when of the HIA. It is the outline of the impact analysis including the data on the relevant baseline characteristics of the target population. In this phase the assessment model and tools are decided on, the policies and legislation applicable and what evidence is available to profile the assessment population. The reporting procedures are also set out in this phase. Hereafter the assessment is carried out. The stakeholders and affected persons (community) are kept informed throughout the assessment process. Their input is incorporated into the assessment. The assessors then carry out the assessment according to the approved Terms of reference. The relevant reports are drafted and presented to the proponents and stakeholders for acceptance and finalised for incorporation in an EIA or given to the commissioners of the HIA.
Who should commission a HIA? HIA is a tool that can be used by both governments and organisations to help them make informed decisions. Companies can use it when proposing new policies and projects. Mining companies should use HIA when expanding their activities, starting new mines and planning the closure of mines. Road agencies should commission a HIA when planning new roads. Property developers planning a new development or planning a new township should use a HIA before they commit to a project. The World Bank and large financial institutions are now starting to require an HIA before approving loans. Government should use HIA before approving any policy, programme or project. Governments throughout the world are starting to recognise the benefits of using HIA, some have even made it obligatory. Finally, every EIA should include a HIA
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