18 November 2010

The advocacy of science and the science of advocacy in harm reduction

This is an excellent lecture and well worth reading in full. The download link is provided below. It raises issues that HIA practitioners also grapple with in their interactions with policy and decision-makers. Can HIA practitioners play a role in developing the science of advocacy?

At a lecture yesterday at the London School of Hygiene and Tropical Medicine (where I did my MSc and PhD) Prof. Stimson made the case for a revolution in Public Health, shifting the focus from the 'bad behaviour' of individual to the 'bad  behaviour' of policy makers who ignore the powerful scientific evidence  behind harm reduction

Prof. Stimson was a member of the first group of researchers to evaluate needle exchange programmes in the United Kingdom in the mid 1980´s at the beginning of the HIV/AIDS epidemic. He was also on the Advisory Council on the Misuse of Drugs committee that designed the United Kingdom harm reduction response. That was a public health success, and emulated in other countries. Stimson says that public health policy requires a new revolution that starts to look at why policy makers continue to behave “badly” and ignore all the consistent scientific evidence presented to them when it came to decision making.

“For too long, public health has focused on the powerless, trying to get drug users, and drinkers and smokers to change their risky behaviour,...Why are there so many studies of the knowledge, attitudes and behaviours of drug users and so few studies of the knowledge, attitudes and behaviours of policy makers when it is the behaviours of the latter that are a much more important problem?”

He argues there are a number of reasons behind this “bad” behaviour of policy makers. Key among them is that drugs policy has to fit with the current ‘big political idea’.

In the lecture Prof. Stimson traces the history of science and advocacy in the field of Harm Reduction from his early days as a researcher, his time as a consultant to the World Health Organisation through to his period as head of the International Harm Reduction Association. He argues that science has been important in the development of harm reduction policy and cite examples where its take up has been both broadly implemented in many countries (drink driving, needle exchange) and marginalised (alternatives to smokeable tobacco). He concludes by suggesting that here have been major successes in advocating for harm reduction, but that the science of advocacy is underdeveloped.

15 November 2010

Health Impact Assessment in the Asia Pacific: Special Issue of EIA Review

A special issue of Environmental Impact Assessment Review on Health Impact Assessment in the Asia Pacific has been released - just in time for the HIA2010 Third Asia Pacific HIA Conference in Dunedin.

The articles in the issue are listed below. They're drawn from presentations at the First Asia Pacific HIA Conference in Sydney in 2007 and the Second Asia Pacific HIA Conference in Chiang Mai in 2009.

Please let me know if you have any trouble accessing the articles.

HIA in the Asia Pacific

Editorial: Health Impact Assessment in the Asia Pacific
Ben Harris-Roxas

Articles relating to HIA as a field

1. Harris-Roxas B, Harris E. Differing forms, differing purposes: A typology of health impact assessment. http://dx.doi.org/10.1016/j.eiar.2010.03.003

2. Morgan RK. Health and impact assessment: Are we seeing closer integration? http://dx.doi.org/10.1016/j.eiar.2010.03.009

3. Pennock M, Ura K. Gross national happiness as a framework for health impact assessment. http://dx.doi.org/10.1016/j.eiar.2010.04.003

Articles on HIA programs

4. Harris P, Spickett J. Health impact assessment in Australia: A review and directions for progress. http://dx.doi.org/10.1016/j.eiar.2010.03.002

5. Cameron C, Ghosh S, Eaton SL. Facilitating communities in designing and using their own community health impact assessment tool. http://dx.doi.org/10.1016/j.eiar.2010.03.001

6. Kang E, Lee Y, Harris P, Koh K, Kim K. Health impact assessment in Korea. http://dx.doi.org/10.1016/j.eiar.2010.02.005

7. Kwiatkowski RE. Indigenous community based participatory research and health impact assessment: A Canadian example. http://dx.doi.org/10.1016/j.eiar.2010.02.003

8. Wu L, Rutherford S, Chu C. The need for health impact assessment in China: Potential benefits for public health and steps forward. http://dx.doi.org/10.1016/j.eiar.2010.03.004

Articles on specific HIAs

9. Spickett JT, Brown HL, Katscherian D. Adaptation strategies for health impacts of climate change in Western Australia: Application of a Health Impact Assessment framework. http://dx.doi.org/10.1016/j.eiar.2010.07.001

10. Inmuong U, Rithmak P, Srisookwatana S, Traithin N, Maisuporn P. Participatory health impact assessment for the development of local government regulation on hazard control. http://dx.doi.org/10.1016/j.eiar.2010.03.008

11. Gunning C, Harris P, Mallett J. Assessing the health equity impacts of regional land-use plan making: An equity focussed health impact assessment of alternative patterns of development of the Whitsunday Hinterland and Mackay Regional Plan, Australia. http://dx.doi.org/10.1016/j.eiar.2010.03.005

12. Tugwell A, Johnson P. The Coffs Harbour 'Our Living City Settlement Strategy' Health Impact Assessment. http://dx.doi.org/10.1016/j.eiar.2010.02.004

Americans less healthy than the English but live as long or longer

An article in Medical Daily on some research by the RAND corporation in the USA and the Institute for Fiscal Studies in England found that:

Click her to go directly to the Medical Daily article.

The study found that both disease prevalence and the onset of new disease were higher among Americans for the illnesses studied - diabetes, high-blood pressure, heart disease, heart attack, stroke, chronic lung diseases and cancer. Diabetes and cancer rates were around twice as high in the United States as in England.

However, death rates among Americans were about the same in those aged 55-64 years and lower for those in their 70s as the English research participants.

Two possible explanations have been suggested:
1) The diseases studied result in higher numbers of deaths in England than in the United States. 
2) English participants were diagnosed at a later stage in the disease process than Americans.

The implication being that there is higher quality medical care in the United States than in England for the chronic illnesses studied leading to less deaths from these chronic illnesses.

The study also investigated the relationship between the financial resources of individuals in both countries and how soon they would die in the future.The researchers found that poorer people are more likely to die sooner and consider that the causal pathway between health and wealth is that poor health leads to a reduction in household wealth, rather than being poor causes one's health to decline. Researchers found that the substantial changes in wealth that occurred in the years 1992 and 2002 in the United States through increases in stock prices and housing prices did not alter the probability of subsequent death.

My thoughts are that this makes sense, it is poor people's reduced ability to withstand life stresses that lead to them ageing more quickly and becoming less healthy over time compared to richer people. The reduction in household wealth therefore links to a reduction in resilience or buffering of life stress i.e. that less money in the future means less ability to withstand personal, family crises from the mundane a household repair to future illnesses and the ability to pay for holidays, education and other quality of life improving material goods and services.

It also confirms something that Ben has written about, that healthcare is an important determinant of health and should not be forgotten in low and high income country contexts.

Have I got that right? Or have I missed something?

12 November 2010

HIAs Sought for Study: Australia & New Zealand 2005-2009

There a piece over on Croakey about health impact assessment.

It's partly about the HIA session at the US APHA Conference. It also includes a call for help in finding HIAs in Australia and New Zealand conducted between 2005 and 2009 for a new study I'm involved in.

If you know of any that aren't on the list below I'd love to hear from you.

The study's looking at HIAs conducted in Australia or New Zealand between 2005-2009 that have reports available.

Though this study is focused on HIAs, rather than environmental impact assessments (EIAs), we’re still interested in interested in any EIAs that have discrete health sections. I know that in many EIA reports health is integrated throughout, but if there’s any that you think have had substantive health component, we’d certainly be interested in taking a look at them. The issue of how health is considered within EIA is of course an important one, and we’re currently developing separate research proposals that address this issue specifically.


  • Sydney West Area Health Service Parramatta City Council HIA 2009
  • Equity Focused HIA of the Review of Goodooga Health Service 2009
  • Good for Kids Good For Life Equity Focused Health Impact Assessment 2008
  • Health Impact Assessment of Lithgow City Council’s Strategic Plan 2008
  • Oran Park and Turner Road Health Impact Assessment 2008
  • Coffs Harbour Our Living City Settlement Strategy Health Impact Assessment 2007
  • Greater Western Sydney Urban Development Health Impact Assessment 2007
  • Health Impact Assessment of the Redevelopment of Liverpool Hospital 2007
  • Health Service Realignment Health Impact Assessment 2007
  • Bungendore health impact assessment: urban development in a rural setting 2007
  • Greater Granville Regeneration Strategy Health Impact Assessment 2006
  • Health Impact Assessment of the Wollongoing Foreshore Precinct Project 2006
  • Indigenous Environmental Health Worker Proposal HIA 2006
  • Rapid Equity Focused HIA of the Australian Better Health Initiative: Assessing the NSW components of priorities 1 and 3 2006
  • Healthy Urban Planning: Recommendations from the NSW HIA project 2006
  • Health & Social Impact Assessment of the Lower Hunter Regional Strategy 2006
  • Ban on commercial fishing in the estuarine waters of New South Wales, Australia: Community consultation and social impacts 2006
  • Assessing the health equity impacts of regional land-use plan making: An equity focussed health impact assessment of alternative patterns of development of the Whitsunday Hinterland and Mackay Regional Plan, Australia 2009
  • Flinders Street Redevelopment Project 2008
  • Gold Coast Council Landfill HIA 2009
  • Health and Social Impact Assessment South East Queensland 2005
  • HiAP Water Security Health Lens 2009
  • Equity Focused HIA of the South Australian ABHI School and Community Initiative 2008
  • Preliminary examination of the population health impacts of SASP targets including labour participation 2007
  • Leopold Strategic Footpath Network Health Impact Assessment 2008
  • Hobson HIA 2008
  • Drought Mallee Region HIA 2007
  • Health Impact Assessment in the East Gippsland Shire Council 2005
  • A matter of equity — Case Study Frankston City Council 2005
  • School closure—what is the effect on health? 2005
  • Health Impacts of Climate Change: Adaptation strategies for Western Australia 2007
  • The Role of Stakeholders in HIA: A Landfill Site and Housing Development in Mundijong, Western Australia 2007
  • Whakawateatia Hawke’s Bay District Health Board: Health Impact Assessment on the proposed Air Quality Plan Change 2009
  • Wairarapa Non-fluoridation of water WOHIA 2009
  • Makoura Responsibility Model 2009
  • Auckland Regional Transport Strategy HIA 2009Health Impact Assessment on the draft Wairoa District Council Waste Management Activity Management Plan 2009
  • HIA of Flaxmere Town Centre, Urban Design Framework 2009
  • HIA Implementation of Oral Health Strategy Location of a Community Clinic in Flaxmere 2009
  • An Age-Friendly Community: Shaping the future for Waihi Beach HIA 2009
  • Manukau Built Form and Spatial Structure Plan HIA Report 2008
  • Christchurch South West Area Social and Health Assessment 2008
  • McLennan Housing Development, Papakura HIA 2008
  • Proposed Liquor Restriction Extensions in North Dunedin HIA 2008
  • Ranui Urban Concept Plan HIA 2008
  • Tokoroa Warm Homes Clean Air Project: Health and Well-being Impact Assessment 2008
  • Health Impact Assessment of Central Plains Water Scheme 2008
  • Health Impact Assessment of the Greater Wellington Regional Policy Statement Regional Form and Energy Draft Provisions 2008
  • Kerikei-Waipapa Draft Structure Plan 2007
  • Greater Christchurch Urban Development Strategy Health Impact Assessment 2006
  • Greater Wellington Regional Land Transport Strategy Health Impact Assessment 2006
  • Healthy, Wealthy and Wise: A Health Impact Assessment of Electricity Scenarios for New Zealand 2005-2050 2006
  • Mangere Let’s Beat Diabetes Health Impact Assessment. 2006
  • Social Impact Assessment of the Draft Nelson City Council Gambling Policy 2006
  • Avondale’s Future Framework rapid HIA: final report 2005
  • Hastings Graffiti HIA 2005
  • Wairau Road Widening HIA 2005

9 November 2010

Minimum Elements & Practice Standards for Health Impact Assessment

From the American Practice Standards subgroup:
The HIA of the Americas Practice Standards subgroup is excited to release an updated version of the “Minimum Elements and Practice Standards for Health Impact Assessment (HIA).”

Minimum Elements answer the question of “what essential elements constitute an HIA” as distinct from Practice Standards, which answer the question, “how to best conduct an HIA.”

Overall, the hope is to translate the values underlying HIA along with key lessons from HIA practice into specific standards for practice for each phase of the HIA process.

The document can be found on Human Impact Partners' website, at
The most interesting aspect to me is the new section on what constitutes the essential characteristics of an HIA:
  1. Is initiated to inform a decision-making process, and conducted in advance of a policy, plan, program, or project decision;
  2. Utilizes a systematic analytic process with the following characteristics:
    2.1. Includes a scoping phase that comprehensively considers potential impacts on health outcomes as well as on social, environmental, and economic health determinants, and selects potentially significant issues for impact analysis;
    2.2. Solicits and utilizes input from stakeholders;
    2.3. Establishes baseline conditions for health, describing health outcomes, health determinants, affected populations, and vulnerable sub-populations;
    2.4. Uses the best available evidence to judge the magnitude, likelihood, distribution, and permanence of potential impacts on human health or health determinants;
    2.5. Rests conclusions and recommendations on a transparent and context-specific synthesis of evidence, acknowledging sources of data, methodological assumptions, strengths and limitations of evidence and uncertainties;
  3. Identifies appropriate recommendations, mitigations and/or design alternatives to protect and promote health;
  4. Proposes a monitoring plan for tracking the decisionʼs implementation on health impacts/determinants of concern;
  5. Includes transparent, publicly-accessible documentation of the process, methods, findings, sponsors, funding sources, participants and their respective roles.

5 November 2010

UNSW HIA eNews Issue 24: Health impact assessment news & resources

The 24th issue of the UNSW Health Impact Assessment eNews is now available.

In this issue:
  • HIA2010 Third Asia Pacific Health Impact Assessment Conference
  • Health impacts of the Gulf of Mexico Oil Spill
  • Five Years of the HIA Blog
  • HIA of a Wind Farm
  • An Asia Pacific Health Impact Network
  • If social support is so important for our health, why doesn’t it get more attention?
  • Quantifying the health impacts of policies
  • YouCommNews: A new media experiment
  • HIA Round-Up

This issue also includes the latest IUHPE HIA Global Working Group Round-Up, with more than 100 links to HIA-related news, resources, events and training. It's at the back of the eNews.

Unintentional side-effects of local renewable electricity production

An interesting point from a VentureBeat blog post "Smart grid could mean your energy bill goes up". Click here to go to the original post.

It points out that a homeowners who can afford solar panels and wind turbines create their own self-sufficient local energy and storage clusters that this may mean that many residents and even whole neighbourhoods disappear from the current national grids meaning that energy utilities will have to charge the remaining customers more.

This is likely to mean that it will be the less well off who a) don't benefit from the tax incentives and savings that local renewable energy systems may bring as well as b) paying more for their electricity from the major energy utilities.

So while sustainable energy use increases health and social inequalities may widen.

1 November 2010

WHO/Europe concludes mission on health impact of sludge spill in Hungary

A four-day WHO expert field mission to Hungary concluded on 16 October by making recommendations to minimize the short- and long-term health impact of a sludge spill at an alumina plant of Magyar Alumínium Zrt. (MAL Zrt.), Ajkai Timfoldgyar in the town of Ajka, and to prevent similar events with potential transboundary effects.

Acute health risk diminished

The spill caused 9 deaths and over 150 injuries, mostly due to drowning and chemical burns from the corrosive effect of the red mud. It destroyed or severely damaged over 300 houses in the villages of Kolontár, Devecser and Somlóvásárhely in western Hungary. At the affected sites, measures were promptly taken to neutralize the corrosive mud and reduce the immediate danger of exposure. As the sludge has receded and its pH decreased, the risk of direct health damage from contact has been substantially reduced.

Focus on resident population and rescue workers

As the recovery and rehabilitation phase is under way, particular attention now needs to be paid to preventing potential health risks to the population of the affected areas, and the nearly 4000 rescue workers and volunteers involved in the clean-up. Exposure to the mud by contact, inhalation or ingestion should be minimized. This requires completing the removal of the sludge from the affected areas (particularly houses), monitoring the concentration of outdoor and indoor air pollutants, and providing the population and first-line workers with clear advice on protecting themselves. As the psychological effects of the disaster are recognized, a specialized team of Hungarian psychologists is providing support on site to people who have been evacuated, suffered injuries and/or deaths in their families, and/or sustained losses of and damage to property. This need will persist for both the short and medium terms.

No danger to health from drinking-water

Importantly, the quality of drinking-water supplied to the affected areas has remained adequate and poses no health risk to the community. Continued monitoring of outdoor and indoor air, drinking-water and the quality of soil and food production will remain essential to assess the risk of exposure, particularly to heavy metals, in the medium and long terms and to take action as required.

No risk from international spread

Great effort has been dedicated to preventing the further spread of the spill to the river Danube, as this could result in environmental damage to neighbouring countries. The information available indicates that the quality of Danube water has remained substantially unaffected. Nevertheless, with some 150 waste reservoirs located along the river, the spill highlights the need for comprehensive mapping and assessment of these installations, their resilience to extreme weather events and to any risk of contamination of soil and ground water from poorly isolated reservoirs. Risk from currently used and heritage industrial sites is common to many countries in the lower Danube. Existing policy instruments, such as the Protocol on Water and Health, can support action to identify and remediate particularly contaminated sites with a potential to harm health through water contamination.

Extract from WHO website. Click here to go to the webpage.