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Health Impact Assessment: Realizing Its Potential

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 August 2014) | Viewed by 104404

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Prof. Dr. Jeffery Spickett

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WHO Collaborating Centre for Environmental Health Impact Assessment, School of Public Health, Curtin University, Perth, WA 6102, Australia
Interests: health impact assessment; health risk assessment; environmental health; occupational health
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Dear Colleagues,

Many countries have processes for identifying, evaluating, and controlling the potential adverse environmental impacts of development projects and other new activities. However, these processes, usually referred to as Environmental Impact Assessments (EIAs), have not been very effective in preventing adverse impacts on human health. Consequently, a Health Impact Assessment process was advocated in the mid- to late-1980s. Over the ensuing years, this process has gained acceptance as an approach that is either integrated into the EIA process or that is carried out separately.

The HIA process considers, from environmental parameters, both the positive and negative impacts of new activities. These parameters include the physical, chemical, biological, and psychosocial aspects of human health and well-being. HIA processes have been adopted by several international agencies to evaluate development projects; such processes have progressed in diversity, depth, and level of complexity. However, this progress has been inconsistent for several reasons. Nevertheless, HIAs have demonstrated potential value (internationally) in preventing the negative and enhancing the positive health impacts of development projects, policies, plans, and programs.

This Special Issue in the IJERPH aims to advance the field of Health Impact Assessments with a range of contributions that reflect the topic’s complexity. The main steps in the HIA process will be considered as well as recent advances in approaches that improve the HIA process and its application. HIAs have not yet achieved the acceptance levels possessed by EIAs and papers that consider the various factors that explain this are also welcome. Such papers may consider why support from stakeholders fluctuates, the role of HIAs in the decision-making process, the limitations (e.g., in terms of capacity and expertise) to one’s ability to carry out HIAs, the lack of clarity and consistency in approaches to HIAs, and the lack of appreciation for the role of HIAs.

This issue will also cover the technical aspects involved in HIAs. Such aspects include data collection, risk assessment and management, monitoring, and review. Case studies concerning the use and application of HIAs that demonstrate their value will also be considered (e.g., studies discussing the use of the HIA framework to investigate the health impacts of climate change and to set air quality standards, among other potential applications). This Special Issue will attempt to provide up-to-date coverage of HIAs as valuable assets, in a variety of scenarios, for both preventing adverse impacts and enhancing the positive impacts on human health generated by new activities.

Prof. Dr. Jeffery Spickett
Guest Editor

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Keywords

health impact assessment
process
decision-making
capacity
risk assessment
risk management
case studies
international
application

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Published Papers (13 papers)

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Editorial

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613 KiB

Open AccessEditorial

Health Impact Assessment: Improving Its Effectiveness in the Enhancement of Health and Well-Being

by Jeffery Spickett, Dianne Katscherian, Helen Brown and Krassi Rumchev

Int. J. Environ. Res. Public Health 2015, 12(4), 3847-3852; https://doi.org/10.3390/ijerph120403847 - 3 Apr 2015

Cited by 7 | Viewed by 5650

Abstract

Most countries in the world have Environmental Impact Assessment (EIA) processes and procedures to evaluate the potential impact of development projects on the environment. This process, which attempts to predict the potential adverse effects of the proposed development project on the environment, is normally legislated and is part of the approval process for the project. Although these processes have been effective in reducing the adverse impacts on the environment they have been limited in their ability to provide protection for the health and well-being of people affected by the development. [...] Full article

(This article belongs to the Special Issue Health Impact Assessment: Realizing Its Potential)

Research

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1602 KiB

Open AccessArticle

Healthy Vinton: A Health Impact Assessment Focused on Water and Sanitation in a Small Rural Town on the U.S.-Mexico Border

by William L. Hargrove, Patricia M. Juárez-Carillo and Marcelo Korc

Int. J. Environ. Res. Public Health 2015, 12(4), 3864-3888; https://doi.org/10.3390/ijerph120403864 - 7 Apr 2015

Cited by 19 | Viewed by 7824

Abstract

We conducted a Health Impact Assessment (HIA) focused on water and sanitation in Vinton, TX, a small rural town on the U.S./Mexico Border. We present the Vinton HIA as a case study to inform the practice of HIA in rural limited resource communities with higher than average levels of unemployment and poverty, and limited infrastructure. Household surveys, focus groups, and interviews provided quantitative and qualitative data on water sources and quality, sanitation practices, and community health. We found that some of the current water sources in Vinton did not meet drinking water standards for total dissolved solids and arsenic; the majority of septic tanks were not managed properly; and there was a short-term risk of water scarcity due to prolonged drought in the region. Prevalent ailments reported by participants included stomach problems, diarrhea, and skin problems. These ailments can be related to arsenic and/or biological organisms in water. The positive direct and indirect health impacts of improved water and sanitation in Vinton included: reduced gastrointestinal illnesses and skin disorders; improved water quality, quantity, and pressure; reduced risks from failing septic systems; increased property value; potential economic growth; and enhanced quality of life. The negative direct and indirect impacts included: residents’ initial and monthly costs; increased property taxes; increased debt by local government; and the need for ongoing support from changing elected decision makers. The unique challenges in completing this HIA included: (a) limited available data; (b) a culture of fear and distrust among residents; (c) residents’ lack of education, awareness, and civic discourse regarding water and sanitation issues and their impact on public health; and (d) lack of civic discourse and participation in the democratic process. An important outcome of the HIA was the characterization of local water supplies, which motivated and empowered the community members to become more involved in civic discourse concerning their water supplies. Results are transferable to similar low-income rural communities worldwide where residents are lacking in information about their water supplies and in political “voice”. Full article

(This article belongs to the Special Issue Health Impact Assessment: Realizing Its Potential)

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Open AccessArticle

Changing Patterns of Health in Communities Impacted by a Bioenergy Project in Northern Sierra Leone

by Astrid M. Knoblauch, Mary H. Hodges, Mohamed S. Bah, Habib I. Kamara, Anita Kargbo, Jusufu Paye, Hamid Turay, Emmanuel D. Nyorkor, Mark J. Divall, Yaobi Zhang, Jürg Utzinger and Mirko S. Winkler

Int. J. Environ. Res. Public Health 2014, 11(12), 12997-13016; https://doi.org/10.3390/ijerph111212997 - 12 Dec 2014

Cited by 20 | Viewed by 7656

Abstract

Large private sector investments in low- and middle-income countries are often critically evaluated with regards to their environmental, social, human rights, and health impacts. A health impact assessment, including a baseline health survey, was commissioned by the Addax Bioenergy Sierra Leone project in 2010. As part of the monitoring, a follow-up survey was conducted three years later. A set of health indicators was assessed at six impacted and two control sites. Most of these indices improved, particularly at the impacted sites. The prevalences of stunting, wasting, and Plasmodium falciparum in children under five years of age decreased significantly at impacted sites (all p < 0.05) and non-significantly at control sites. Anemia in children and in women of reproductive age (15–49 years) decreased significantly at impacted and control sites (p < 0.05 and p < 0.001, respectively). Health facility-based deliveries increased significantly at the impacted sites (p < 0.05). The prevalences of helminth infections in children aged 10–15 years remained approximately at the same levels, although focal increases at the impacted sites were noted. Access to improved sanitation decreased significantly (p < 0.05) at control and non-significantly at impacted sites. Water quality remained poor without significant changes. The epidemiologic monitoring of a bioenergy project provides a useful contribution for evidence-based decision-making. Full article

(This article belongs to the Special Issue Health Impact Assessment: Realizing Its Potential)

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Open AccessArticle

A Health Impact Assessment Framework for Assessing Vulnerability and Adaptation Planning for Climate Change

by Helen Brown, Jeffery Spickett and Dianne Katscherian

Int. J. Environ. Res. Public Health 2014, 11(12), 12896-12914; https://doi.org/10.3390/ijerph111212896 - 12 Dec 2014

Cited by 18 | Viewed by 9324

Abstract

This paper presents a detailed description of an approach designed to investigate the application of the Health Impact Assessment (HIA) framework to assess the potential health impacts of climate change. A HIA framework has been combined with key climate change terminology and concepts. The fundamental premise of this framework is an understanding of the interactions between people, the environment and climate. The diversity and complexity of these interactions can hinder much needed action on the critical health issue of climate change. The objectives of the framework are to improve the methodology for understanding and assessing the risks associated with potential health impacts of climate change, and to provide decision-makers with information that can facilitate the development of effective adaptation plans. While the process presented here provides guidance with respect to this task it is not intended to be prescriptive. As such, aspects of the process can be amended to suit the scope and available resources of each project. A series of working tables has been developed to assist in the collation of evidence throughout the process. The framework has been tested in a number of locations including Western Australia, Solomon Islands, Vanuatu and Nauru. Full article

(This article belongs to the Special Issue Health Impact Assessment: Realizing Its Potential)

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Health Impact Assessment Practice and Potential for Integration within Environmental Impact and Strategic Environmental Assessments in Italy

by Nunzia Linzalone, Giorgio Assennato, Adele Ballarini, Ennio Cadum, Mario Cirillo, Liliana Cori, Francesca De Maio, Loredana Musmeci, Marinella Natali, Sabrina Rieti, Maria Eleonora Soggiu and Fabrizio Bianchi

Int. J. Environ. Res. Public Health 2014, 11(12), 12683-12699; https://doi.org/10.3390/ijerph111212683 - 8 Dec 2014

Cited by 19 | Viewed by 8564

Abstract

Avoiding or minimizing potential environmental impact is the driving idea behind protecting a population’s health via Environmental Impact Assessments (EIAs) and Strategic Environmental Assessments (SEAs). However, both are often carried out without any systematic approach. This paper describes the findings of a review of HIA, EIA and SEA experiences carried out by the authors, who act as institutional competent subjects at the national and regional levels in Italy. The analysis of how health is tackled in EIA and SEA procedures could support the definition of a protocol for the integration of HIA with EIA and SEA. Although EIA and SEA approaches include the aim of protecting health, significant technical and methodological gaps are present when assessing health systematically, and their basic principles regarding assessment are unsatisfactory for promoting and addressing healthcare concepts stated by the WHO. HIA is still poorly integrated into the decision-making process, screening and monitoring phases are only occasionally implemented, and operational details are not well-defined. The collaborative approach of institutions involved in environment and health is a core element in a systematic advancement toward supporting effective decisions and effective protection of the environment and health. At the Italian national level, the definition of guidelines and tools for HIA, also in relation with EIA and SEA, is of great interest. Full article

(This article belongs to the Special Issue Health Impact Assessment: Realizing Its Potential)

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Estimating the Costs and Benefits of Providing Free Public Transit Passes to Students in Los Angeles County: Lessons Learned in Applying a Health Lens to Decision-Making

by Lauren N. Gase, Tony Kuo, Steven Teutsch and Jonathan E. Fielding

Int. J. Environ. Res. Public Health 2014, 11(11), 11384-11397; https://doi.org/10.3390/ijerph111111384 - 31 Oct 2014

Cited by 14 | Viewed by 8396

Abstract

In spite of increased focus by public health to engage and work with non-health sector partners to improve the health of the general as well as special populations, only a paucity of studies have described and disseminated emerging lessons and promising practices that can be used to undertake this work. This article describes the process used to conduct a Health Impact Assessment of a proposal to provide free public transportation passes to students in Los Angeles County. This illustrative case example describes opportunities and challenges encountered in working with an array of cross-sector partners and highlights four important lessons learned: (1) the benefits and challenges associated with broad conceptualization of public issues; (2) the need for more comprehensive, longitudinal data systems and dynamic simulation models to inform decision-making; (3) the importance of having a comprehensive policy assessment strategy that considers health impacts as well as costs and feasibility; and (4) the need for additional efforts to delineate the interconnectivity between health and other agency priorities. As public health advances cross-sector work in the community, further development of these priorities will help advance meaningful collaboration among all partners. Full article

(This article belongs to the Special Issue Health Impact Assessment: Realizing Its Potential)

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Advancing Efforts to Achieve Health Equity: Equity Metrics for Health Impact Assessment Practice

by Jonathan Heller, Marjory L. Givens, Tina K. Yuen, Solange Gould, Maria Benkhalti Jandu, Emily Bourcier and Tim Choi

Int. J. Environ. Res. Public Health 2014, 11(11), 11054-11064; https://doi.org/10.3390/ijerph111111054 - 24 Oct 2014

Cited by 34 | Viewed by 8743

Abstract

Equity is a core value of Health Impact Assessment (HIA). Many compelling moral, economic, and health arguments exist for prioritizing and incorporating equity considerations in HIA practice. Decision-makers, stakeholders, and HIA practitioners see the value of HIAs in uncovering the impacts of policy and planning decisions on various population subgroups, developing and prioritizing specific actions that promote or protect health equity, and using the process to empower marginalized communities. There have been several HIA frameworks developed to guide the inclusion of equity considerations. However, the field lacks clear indicators for measuring whether an HIA advanced equity. This article describes the development of a set of equity metrics that aim to guide and evaluate progress toward equity in HIA practice. These metrics also intend to further push the field to deepen its practice and commitment to equity in each phase of an HIA. Over the course of a year, the Society of Practitioners of Health Impact Assessment (SOPHIA) Equity Working Group took part in a consensus process to develop these process and outcome metrics. The metrics were piloted, reviewed, and refined based on feedback from reviewers. The Equity Metrics are comprised of 23 measures of equity organized into four outcomes: (1) the HIA process and products focused on equity; (2) the HIA process built the capacity and ability of communities facing health inequities to engage in future HIAs and in decision-making more generally; (3) the HIA resulted in a shift in power benefiting communities facing inequities; and (4) the HIA contributed to changes that reduced health inequities and inequities in the social and environmental determinants of health. The metrics are comprised of a measurement scale, examples of high scoring activities, potential data sources, and example interview questions to gather data and guide evaluators on scoring each metric. Full article

(This article belongs to the Special Issue Health Impact Assessment: Realizing Its Potential)

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Open AccessArticle

A Health Impact Assessment of a Proposed Bill to Decrease Speed Limits on Local Roads in Massachusetts (U.S.A.)

by Peter James, Kate Ito, Rachel F. Banay, Jonathan J. Buonocore, Benjamin Wood and Mariana C. Arcaya

Int. J. Environ. Res. Public Health 2014, 11(10), 10269-10291; https://doi.org/10.3390/ijerph111010269 - 2 Oct 2014

Cited by 8 | Viewed by 7613

Abstract

Decreasing traffic speeds increases the amount of time drivers have to react to road hazards, potentially averting collisions, and makes crashes that do happen less severe. Boston’s regional planning agency, the Metropolitan Area Planning Council (MAPC), in partnership with the Massachusetts Department of Public Health (MDPH), conducted a Health Impact Assessment (HIA) that examined the potential health impacts of a proposed bill in the state legislature to lower the default speed limits on local roads from 30 miles per hour (mph) to 25 mph. The aim was to reduce vehicle speeds on local roads to a limit that is safer for pedestrians, cyclists, and children. The passage of this proposed legislation could have had far-reaching and potentially important public health impacts. Lower default speed limits may prevent around 18 fatalities and 1200 serious injuries to motorists, cyclists and pedestrians each year, as well as promote active transportation by making local roads feel more hospitable to cyclists and pedestrians. While a lower speed limit would increase congestion and slightly worsen air quality, the benefits outweigh the costs from both a health and economic perspective and would save the state approximately $62 million annually from prevented fatalities and injuries. Full article

(This article belongs to the Special Issue Health Impact Assessment: Realizing Its Potential)

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The Value of Mainstreaming Human Rights into Health Impact Assessment

by Gillian MacNaughton and Lisa Forman

Int. J. Environ. Res. Public Health 2014, 11(10), 10076-10090; https://doi.org/10.3390/ijerph111010076 - 26 Sep 2014

Cited by 6 | Viewed by 5308

Abstract

Health impact assessment (HIA) is increasingly being used to predict the health and social impacts of domestic and global laws, policies and programs. In a comprehensive review of HIA practice in 2012, the authors indicated that, given the diverse range of HIA practice, there is an immediate need to reconsider the governing values and standards for HIA implementation [1]. This article responds to this call for governing values and standards for HIA. It proposes that international human rights standards be integrated into HIA to provide a universal value system backed up by international and domestic laws and mechanisms of accountability. The idea of mainstreaming human rights into HIA is illustrated with the example of impact assessments that have been carried out to predict the potential effects of intellectual property rights in international trade agreements on the availability and affordability of medicines. The article concludes by recommending international human rights standards as a legal and ethical framework for HIA that will enhance the universal values of nondiscrimination, participation, transparency and accountability and bring legitimacy and coherence to HIA practice as well. Full article

(This article belongs to the Special Issue Health Impact Assessment: Realizing Its Potential)

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Open AccessArticle

Health Consequence Scales for Use in Health Impact Assessments of Climate Change

by Helen Brown and Jeffery Spickett

Int. J. Environ. Res. Public Health 2014, 11(9), 9607-9620; https://doi.org/10.3390/ijerph110909607 - 16 Sep 2014

Cited by 10 | Viewed by 6702

Abstract

While health impact assessment (HIA) has typically been applied to projects, plans or policies, it has significant potential with regard to strategic considerations of major health issues facing society such as climate change. Given the complexity of climate change, assessing health impacts presents new challenges that may require different approaches compared to traditional applications of HIA. This research focuses on the development of health consequence scales suited to assessing and comparing health effects associated with climate change and applied within a HIA framework. This assists in setting priorities for adaptation plans to minimize the public health impacts of climate change. The scales presented in this paper were initially developed for a HIA of climate change in Perth in 2050, but they can be applied across spatial and temporal scales. The design is based on a health effects pyramid with health measures expressed in orders of magnitude and linked to baseline population and health data. The health consequence measures are combined with a measure of likelihood to determine the level of risk associated with each health potential health impact. In addition, a simple visual framework that can be used to collate, compare and communicate the level of health risks associated with climate change has been developed. Full article

(This article belongs to the Special Issue Health Impact Assessment: Realizing Its Potential)

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A Health Impact Assessment of Proposed Public Transportation Service Cuts and Fare Increases in Boston, Massachusetts (U.S.A.)

by Peter James, Kate Ito, Jonathan J. Buonocore, Jonathan I. Levy and Mariana C. Arcaya

Int. J. Environ. Res. Public Health 2014, 11(8), 8010-8024; https://doi.org/10.3390/ijerph110808010 - 7 Aug 2014

Cited by 24 | Viewed by 10869

Abstract

Transportation decisions have health consequences that are often not incorporated into policy-making processes. Health Impact Assessment (HIA) is a process that can be used to evaluate health effects of transportation policy. We present a rapid HIA, conducted over eight weeks, evaluating health and economic effects of proposed fare increases and service cuts to Boston, Massachusetts’ public transportation system. We used transportation modeling in concert with tools allowing for quantification and monetization of multiple pathways. We estimated health and economic costs of proposed public transportation system changes to be hundreds of millions of dollars per year, exceeding the budget gap the public transportation authority was required to close. Significant health pathways included crashes, air pollution, and physical activity. The HIA enabled stakeholders to advocate for more modest fare increases and service cuts, which were eventually adopted by decision makers. This HIA was among the first to quantify and monetize multiple pathways linking transportation decisions with health and economic outcomes, using approaches that could be applied in different settings. Including health costs in transportation decisions can lead to policy choices with both economic and public health benefits. Full article

(This article belongs to the Special Issue Health Impact Assessment: Realizing Its Potential)

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Review

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Open AccessReview

Health Impact Assessment of Urban Waterway Decisions

by Katrina Smith Korfmacher, Katia Aviles, B.J. Cummings, William Daniell, Jared Erdmann and Valerie Garrison

Int. J. Environ. Res. Public Health 2015, 12(1), 300-321; https://doi.org/10.3390/ijerph120100300 - 25 Dec 2014

Cited by 14 | Viewed by 8627

Abstract

Health impact assessments (HIA) promote the consideration of health in a wide range of public decisions. Although each HIA is different, common pathways, evidence bases, and strategies for community engagement tend to emerge in certain sectors, such as urban redevelopment, natural resource extraction, or transportation planning. To date, a limited number of HIAs have been conducted on decisions affecting water resources and waterfronts. This review presents four recent HIAs of water-related decisions in the United States and Puerto Rico. Although the four cases are topically and geographically diverse, several common themes emerged from the consideration of health in water-related decisions. Water resource decisions are characterized by multiple competing uses, inter-institutional and inter-jurisdictional complexity, scientific uncertainty, long time scales for environmental change, diverse cultural and historical human values, and tradeoffs between private use and public access. These four case studies reveal challenges and opportunities of examining waterfront decisions through a “health lens”. This review analyzes these cases, common themes, and lessons learned for the future practice of HIA in the waterfront zone and beyond. Full article

(This article belongs to the Special Issue Health Impact Assessment: Realizing Its Potential)

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Open AccessOpinion

Assessing Health Impacts within Environmental Impact Assessments: An Opportunity for Public Health Globally Which Must Not Remain Missed

by Patrick Harris, Francesca Viliani and Jeff Spickett

Int. J. Environ. Res. Public Health 2015, 12(1), 1044-1049; https://doi.org/10.3390/ijerph120101044 - 20 Jan 2015

Cited by 31 | Viewed by 8106

Abstract

Within the member states of the United Nations 190 of 193 have regulated Environmental Impact Assessments (EIA) which is a systematic process to prevent and mitigate the potential environmental impacts of industry development projects before these occur. However, the routine and comprehensive assessment of health impacts within EIAs remains underdeveloped. Focusing, as an example, on the risks to global health from the global shift in the mining industry towards Low and Middle Income Countries LMIC), this viewpoint details why connecting with EIA is an essential task for the health system. Although existing knowledge is out of date in relation to global practice we identify how health has been included, to some extent, in High Income Country EIAs and the institutional requirements for doing so. Using arguments identified by industry themselves about requiring a ‘social license to operate’, we conclude that EIA regulations provide the best current mechanism to ensure health protection is a core aspect in the decision making process to approve projects. Full article

(This article belongs to the Special Issue Health Impact Assessment: Realizing Its Potential)

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