Intervention Strategies for Public Intervention Strategies for Public Health in Urban planning and Health in Urban planning and

LandscapesLandscapes

Carlos DoraCarlos DoraWorld Health OrganizationWorld Health Organization

GenevaGeneva

This presentationThis presentation

Public Health and the Urban LandscapePublic Health and the Urban Landscape Reasons for PH to interveneReasons for PH to intervene Key role of PH experts and Health Key role of PH experts and Health

AuthoritiesAuthorities Tools for stewardship: HIA, monitoring Tools for stewardship: HIA, monitoring

and reporting, communication and and reporting, communication and partnerships partnerships

Opportunities: policies to respond to the Opportunities: policies to respond to the economic crisis and to climate changeeconomic crisis and to climate change

1. Public Health in the 1. Public Health in the Urban LandscapeUrban Landscape

Environmental and social Environmental and social determinantsdeterminants

Many depend on actions by Many depend on actions by other sectorsother sectors

Public health gains of the Public health gains of the 19th century – from water, 19th century – from water, sanitation and housing sanitation and housing interventionsinterventions

Similar in 21Similar in 21stst century – century – transport and urban planning, transport and urban planning, housing, employment policies housing, employment policies

Examples:Examples:

TransportTransport HousingHousing

Many health impacts from Many health impacts from transport: but dealt with transport: but dealt with

separatelyseparately

INJURIESNOISE

AIR POLLUTION

PHYSICAL INACTIVITY

PSYCHOSOCIALEFFECTS

The importance of 'transport related' diseasesThe importance of 'transport related' diseases

(WHO, World Health Report, 2002)(WHO, World Health Report, 2002)

Each year:Each year:

Urban air pollution kills 800,000Urban air pollution kills 800,000

Road traffic accidents kill 1.2 million and injure over 50 Road traffic accidents kill 1.2 million and injure over 50 millionmillion

Physical inactivity causes 1.9 million deaths, and loss of Physical inactivity causes 1.9 million deaths, and loss of 19 million years of healthy life 19 million years of healthy life

For comparisonFor comparison::Malaria Malaria - 1.1 million- 1.1 millionHIV/AIDS HIV/AIDS - 2.9 million- 2.9 millionTobacco-relatedTobacco-related - 4.9 million- 4.9 million

Narrow solutions: limited Narrow solutions: limited results. results. e.g. Continuing Traffic e.g. Continuing Traffic

Growth Has Cancelled Out Pollution Growth Has Cancelled Out Pollution Savings from Cleaner and More Savings from Cleaner and More

Efficient VehiclesEfficient Vehicles

Cars are becoming Cars are becoming heavier and more heavier and more powerful.powerful.

Trips are becoming Trips are becoming increasingly longincreasingly long..

Total kilometers Total kilometers traveled by road traveled by road continues to growcontinues to grow

EC: Transport in Figures, 2000

'Business as usual' health trends'Business as usual' health trends

• Vast increase in car ownership and larger cars in emerging economies vs. better regulation, more efficient engines.

• Road traffic accident deaths to double from 1990-2020.

• Global Epidemic of Obesity.

(WHO, 1996; WHO, 2004)(WHO, 1996; WHO, 2004)

Different routes are possibleDifferent routes are possible

Kenworthy, 2003

Atlanta

Zurich

London

Singapore

Hong Kong

Houston

Beijing

Bangkok

Great potential for improvement in physically active Great potential for improvement in physically active transporttransport

Percentage of people walking or cycling to work:

Copenhagen 32 %Santiago 30 %Tokyo 22 %Brasilia 2 %Atlanta 0.3 %

Percentage of urban trips by motorised private transport:

USA 89 %Western Europe 50 %High Income Asia 42 %China 16 %

Traffic policies can have many benefits Traffic policies can have many benefits to health and environmentto health and environment

Source: Congestion Charging: Update on scheme impacts and operations. February 2004Source: Congestion Charging: Update on scheme impacts and operations. February 2004

((www.tfl.gov.uk/tfl/downloads/pdf/congestion-charging/cc-12monthson.pdfwww.tfl.gov.uk/tfl/downloads/pdf/congestion-charging/cc-12monthson.pdf))

The congestion charge is a £5 daily charge for driving or parking a The congestion charge is a £5 daily charge for driving or parking a vehicle on public roads within the congestion charging zone vehicle on public roads within the congestion charging zone between 07:00 and 18:30, Monday to Friday, excluding between 07:00 and 18:30, Monday to Friday, excluding weekends and public holidays.weekends and public holidays.

Traffic delays inside the charging zone average 30% Traffic delays inside the charging zone average 30% lower than before lower than before

Pedal cycle movements have Pedal cycle movements have increased by about 20 %increased by about 20 %

Bus and coach movements have increased by over 20% Bus and coach movements have increased by over 20% Van and lorry movements have reduced by about 10 %Van and lorry movements have reduced by about 10 % Powered two-wheeler movements have increased by Powered two-wheeler movements have increased by

10-15%10-15%

8% reduction in personal injury 8% reduction in personal injury accidentsaccidents in the charging zone in the charging zone during charging hours during charging hours compared to the same period compared to the same period last year. last year.

6% fewer pedestrians were involved in accidents, 6% fewer pedestrians were involved in accidents, (Based on the first 6 months of provisional data since (Based on the first 6 months of provisional data since

charging began)charging began)

London congestion chargeLondon congestion charge

Bogota: urban space to public transport Bogota: urban space to public transport and pedestrians – reduction in traffic and pedestrians – reduction in traffic injuries and air pollution + political injuries and air pollution + political

successsuccess

before... ... after

There is a need for integrated There is a need for integrated policies that address all health policies that address all health

impacts, environment and impacts, environment and development:development:

Transport Demand Transport Demand Management viaManagement via: :

– Economic measures Economic measures

– Changes in individual Changes in individual travel behaviours travel behaviours

– Compact land use to Compact land use to reduce need to travelreduce need to travel

Maintain high walking Maintain high walking and cyclingand cycling

Support public Support public transporttransport

Housing And Health Housing And Health

INSIDE

OUTSIDE

PHYSICAL

Family and homeFamily and home

Crowding, isolation, depression, Crowding, isolation, depression, infectious diseases, accessibility infectious diseases, accessibility and ageing, etc.and ageing, etc.

DwellingDwelling

Mould / damp, allergens, pests, Mould / damp, allergens, pests, building emissions, ETS, VOC, building emissions, ETS, VOC, PM, lead, radon, asbestos, EMF, PM, lead, radon, asbestos, EMF, accidents, thermal conditions, accidents, thermal conditions, noise, sanitation, etc.noise, sanitation, etc.

NeighbourhoodNeighbourhood

Social problems, crime, fear, Social problems, crime, fear, neighbourhood deprivation, lack of neighbourhood deprivation, lack of control, etc.control, etc.

Housing environmentHousing environment

Noise, air pollution, lack of Noise, air pollution, lack of recreational areas, lack of physical recreational areas, lack of physical activity, accidents, etc.activity, accidents, etc.

PSYCHO-SOCIAL

OUTSIDEOUTSIDE

Health hazards in Health hazards in constructionconstruction

Risks of accidentsRisks of accidents – falls, cuts, – falls, cuts, electrocutionelectrocution

Chemical risks Chemical risks – silica, asbestos, glues, – silica, asbestos, glues, powderspowders

Physical risksPhysical risks – noise, vibration, heat, – noise, vibration, heat, cold, UVcold, UV

Ergonomic risksErgonomic risks – heavy weights, twisting, – heavy weights, twisting, awkward positionsawkward positions

Social factorsSocial factors – migrant workers, long – migrant workers, long working hours, limited social support working hours, limited social support

Fatal and disabling injuries Fatal and disabling injuries (42% of work-(42% of work-related deaths in Japan)related deaths in Japan)

Occupational diseases Occupational diseases – silicosis, – silicosis, mesothelioma, hearing loss, dermatitis, mesothelioma, hearing loss, dermatitis, musculoskeletal disorders, alcoholism, musculoskeletal disorders, alcoholism, depressiondepression

Asbestos in Asbestos in housinghousing

95% of asbestos is used in 95% of asbestos is used in construction materials, e.g. construction materials, e.g. roofingroofing

125 million people exposed125 million people exposed to to asbestos at the workplaceasbestos at the workplace

More than More than 90,000 people die 90,000 people die annually from asbestos related annually from asbestos related diseasesdiseases

Safer alternatives are availableSafer alternatives are available

Preventing exposure is very Preventing exposure is very difficultdifficult

WHO considers that the most WHO considers that the most effective way to eliminate effective way to eliminate asbestos-related diseases is to asbestos-related diseases is to stop the use of all types of stop the use of all types of asbestosasbestos

Tsunami reconstruction Nam Khem Tsunami reconstruction Nam Khem Village, Thailand 2005Village, Thailand 2005

Thermal comfort and excess Thermal comfort and excess winter deaths in the UKwinter deaths in the UK

                                   

                                   

Mortality (all causes) in relation to the lowest point in summer => BLUE LINE: for coldest dwellings=> RED LINE: for hottest dwellings

Wilkinson et al. (2001)

Housing insulation Housing insulation and thermal comfortand thermal comfort

WHO (2008)

Deaths During Summer Heatwave. Paris Funeral Services (2003)

2003 European Summer Heatwave

Mortality housing risk Mortality housing risk factors during French factors during French

heatwave in 2003heatwave in 2003

Building older than 1975:Building older than 1975: OR 1.8 (CI 1.1–2.9)OR 1.8 (CI 1.1–2.9)

Living on the top floor of a building: Living on the top floor of a building: OR 2.3 (CI 1.3-4.1)OR 2.3 (CI 1.3-4.1)

Bedrooms directly under roof:Bedrooms directly under roof: OR 2.2 (CI 1.3–3.7)OR 2.2 (CI 1.3–3.7)

Good insulation (versus bad insulation): Good insulation (versus bad insulation): OR 0.4 (CI 0.3–0.7)OR 0.4 (CI 0.3–0.7)

Number of windows / 50m2 (more vs. Number of windows / 50m2 (more vs. less): less):

OR 1.2 (CI 1.03–1.4)OR 1.2 (CI 1.03–1.4)

Number of Rooms (more versus less):Number of Rooms (more versus less): OR 0.85 (0.72-0.99)OR 0.85 (0.72-0.99)

Source: Vandentorren et al. 2006

Unintentional Injuries Unintentional Injuries (EU-15*)(EU-15*)

130.000 fatalities (54% home & leisure)130.000 fatalities (54% home & leisure)

390.000 disabled (68% home & leisure)390.000 disabled (68% home & leisure)

5.000.000 hospitalised (66% home & leisure)5.000.000 hospitalised (66% home & leisure)

39.000.000 injured (67% home & leisure)39.000.000 injured (67% home & leisure)

Killer No. 1 in age group 1-45 yearsKiller No. 1 in age group 1-45 years

More then 10% of all health costs More then 10% of all health costs

DG SANCO (2004)*15 EU member states only

France, UK and Germany have more home accidents than road traffic accidents!!!

Radon in homes Radon in homes and smokingand smoking

Darby et al, 2005

RADON MITIGATION SYSTEMRADON MITIGATION SYSTEM

A – Gas-permeable layer A – Gas-permeable layer

B - Plastic sheeting B - Plastic sheeting

C - Sealing and caulkingC - Sealing and caulking

D - Vent pipe D - Vent pipe

E - Junction boxE - Junction box

It is recommended that It is recommended that homes be tested for radon on homes be tested for radon on the lowest lived-in level – the lowest lived-in level – basement or ground floorbasement or ground floor

www.epa.gov/iaq/radon/construc.html

Concerns on Housing and Health Concerns on Housing and Health

Electromagnetic FieldsElectromagnetic Fields

Electrical wiring

Electrical appliances

Housing and Health Housing and Health Electromagnetic FieldsElectromagnetic Fields

Radiofrequency fields (e.g. wireless Radiofrequency fields (e.g. wireless technologies)technologies)

Accessible housingAccessible housing

Strongly limited – 4%

Partially limited – 9%

Not limited – 87%

European Disability Forum 2002:% of population being limited in their daily activities due to handicaps (based on Eurostat)

Strongly limited

22%

Not limited47%

Partially limited

31%

...and for the popula-tion above 65 years:

European Disability Forum 2002 / Eurostat 2002

BuildingsIndoor air pollution

Heat and cold protection

Reducing GHG emissions, Reducing GHG emissions, promoting healthpromoting health

Energy supply & conversion

Occupational risks;Construction and transport

AgricultureNutrition,Water /

vector-borne disease

TransportAir pollution

Traffic injuriesPhysical inactivity

IndustryOccupational risks,

mining and transport

WasteOccupational,

chemical

Greenhouse GasEmissions

2. Why governments should 2. Why governments should actact??

To make optimal decisions in view of competing points of view

Health & Environment: “Healthy transport can improve public health, safeguard the environment, enhance access and the economic vitality of cities”

Car and Road lobby: “Benefits outweigh the Costs, the health burden is a price societies pay for mobility and convenience they enjoy.”

1st: To ensure sound economic 1st: To ensure sound economic decisions (utilitarian view)decisions (utilitarian view)

The Market for transport fails to deliver socially optimal The Market for transport fails to deliver socially optimal patterns as patterns as

Transport Costs are Transport Costs are notnot all paid for the user, and the costs all paid for the user, and the costs borne by others (external costs) are substantial.borne by others (external costs) are substantial.

The overall use of transport, particularly more polluting The overall use of transport, particularly more polluting modes, is then higher than socially optimalmodes, is then higher than socially optimal

The right investments and prices (for pollution, accidents The right investments and prices (for pollution, accidents etc.) would correct these distortionsetc.) would correct these distortions

The end result is cost to all society that are not seen by the The end result is cost to all society that are not seen by the individual: individual:

absenteeism to work and costs to businesses, absenteeism to work and costs to businesses, increasingly high health care costs of chronic diseases, increasingly high health care costs of chronic diseases,

2nd. To ensure policy making 2nd. To ensure policy making draws on existing knowledge draws on existing knowledge

and best practice and best practice

Difficulty in accessing information on the Difficulty in accessing information on the health impacts of transport interventionshealth impacts of transport interventions

Myths about what is good practice are Myths about what is good practice are repeated and reinforcedrepeated and reinforced

Scientific evidence is often not translated Scientific evidence is often not translated regarding its implications for policyregarding its implications for policy

A trusted and balanced in formation A trusted and balanced in formation broker is needed broker is needed

3rd. To give a voice and 3rd. To give a voice and protect vulnerable groupsprotect vulnerable groups

Children are vulnerable to injuries, air pollution and Children are vulnerable to injuries, air pollution and noise, their cognitive and physical development noise, their cognitive and physical development require exploration of the neighbourhood and outdoor require exploration of the neighbourhood and outdoor activity. activity.

Children and other vulnerable groups are exposed to Children and other vulnerable groups are exposed to risks from traffic but enjoy few benefits from it.risks from traffic but enjoy few benefits from it.

These groups often do not have a voice to influence These groups often do not have a voice to influence decisions. Governments need to be that voice.decisions. Governments need to be that voice.

44thth. To promote health . To promote health equityequity

Exposure to health risks depends on mode of transport Exposure to health risks depends on mode of transport used used

Need to ensure safety of people using all modes Need to ensure safety of people using all modes

Pedestrians and cyclists do not cause pollution, contribute Pedestrians and cyclists do not cause pollution, contribute to reducing traffic congestion, will use health services to reducing traffic congestion, will use health services less and be more assiduous to work, but are exposed to less and be more assiduous to work, but are exposed to health risks caused by motor vehicle users (injuries, health risks caused by motor vehicle users (injuries, pollution)pollution)

Key role of PH experts and Health Authorities:Key role of PH experts and Health Authorities:

To influence other sectors to incorporate health To influence other sectors to incorporate health objectives into their policies (stewardship)objectives into their policies (stewardship)

Health standards and normsHealth standards and norms Gather relevant knowledge about health Gather relevant knowledge about health

implications of decisionsimplications of decisions Inform and engage stakeholders about Inform and engage stakeholders about

health issues in other sector policieshealth issues in other sector policies Provide feedback about expected and actual Provide feedback about expected and actual

health consequences of policies in other health consequences of policies in other sectors, including health equity aspectssectors, including health equity aspects

– Monitoring system (accountability)Monitoring system (accountability)

– Communicate Positive feedbackCommunicate Positive feedback

Establish partnerships with actors in other Establish partnerships with actors in other sectors and stakeholders sectors and stakeholders

Tools for stewardship: Tools for stewardship: Health Imapct Assessment Health Imapct Assessment

(HIA)(HIA)

" Health impact assessment is a combination of procedures, " Health impact assessment is a combination of procedures, methods and tools that systematically judges the potential, methods and tools that systematically judges the potential, and sometimes unintended, effects of a policy, plan, and sometimes unintended, effects of a policy, plan, programme or project on the health of a population, and the programme or project on the health of a population, and the distribution of those effects within the population. HIA distribution of those effects within the population. HIA identifies appropriate actions to manage those effects."identifies appropriate actions to manage those effects."

- IAIA definition based on the WHO "Gothenburg Consensus Statement" (2006)- IAIA definition based on the WHO "Gothenburg Consensus Statement" (2006)

What is ‘health impact What is ‘health impact assessment’?assessment’?

Prediction Prediction – what are expected impacts ?– what are expected impacts ?

Systematic process & proceduresSystematic process & procedures

Public/stakeholder involvement Public/stakeholder involvement – what are – what are perspectives of those affected?perspectives of those affected?

Link to Policy /Project decision making Link to Policy /Project decision making

Mitigation of adverse effectsMitigation of adverse effects

What is HIA trying to achieve?What is HIA trying to achieve?

Inform/influence decision-making during Inform/influence decision-making during project developmentproject development

Enhance the Enhance the positive health impactspositive health impacts of the of the projectproject

Reduce (or mitigate) the Reduce (or mitigate) the negative health impactsnegative health impacts of the projectof the project

Contributing to reduction in health inequalitiesContributing to reduction in health inequalities

HIA procedureHIA procedure

Screening

Scoping

Appraisal

Reporting

Monitoring

Quickly establishes "health relevance" of the policy or project. Is HIA required?

Identifies key health issues & public concerns, establishes ToR, sets boundaries.

Rapid or in-depth assessment of health impacts using available evidence – who will be affected, baseline, prediction, significance, mitigation.

Conclusions and recommendations to remove/mitigate negative impacts on health or to enhance positive.

Action, where appropriate, to monitor actual impacts on health to enhance existing evidence base.

Policy, programme , or project development phase for prospective assessments.

Policy or project implementation phase

A Generic Health Impact Assessment A Generic Health Impact Assessment methodology methodology

Qualitative and quantitative data collection

Impact analysis

Establish priority impacts

Recommendations developed

Profiling of communities

Policy analysis

Process evaluation

Screening

Scoping

Conduct assessment

Report on health impacts and policy options

Impact and outcome evaluation

Monitoring

Abrahams et al (2004)

‘‘Broad’ versus ‘Tight’ HIA Broad’ versus ‘Tight’ HIA methodologiesmethodologies

‘‘Broad’ Broad’ – socio-environmental socio-environmental

model of healthmodel of health

– key informants/ key informants/ stakeholdersstakeholders

– participatory-focusparticipatory-focus

‘‘Tight’Tight’– bio-medical model of bio-medical model of

healthhealth

– measurement-basedmeasurement-based

– non- participatory non- participatory approachesapproaches

HIA ‘depth’HIA ‘depth’Desk-based Rapid In-depth/

Comprehensive

Broad overview

----Existing

accessible data

----

Days

More detailed

----Existing data

and some new qualitative

----

Weeks

Comprehensive assessment

----Multiple methods

and sources

----

Months

Assessment of Assessment of health risks: health risks:

Causal PathwaysCausal Pathways Causal pathwaysCausal pathways or logic diagrams can be used to map or logic diagrams can be used to map

and examine the relationships between proposed and examine the relationships between proposed activities and health outcomes. activities and health outcomes.

– How does the proposed project and/or related activities affect the How does the proposed project and/or related activities affect the determinants of health? determinants of health?

– Which determinants? Which determinants?

– How strongly? How strongly?

– How are these determinants of health likely to affect the health How are these determinants of health likely to affect the health outcome in the given population?outcome in the given population?

Sample Causal Sample Causal Pathway ModelPathway Model

Employment Policy

Driving Forces

Pressures

State

Exposure

Effect

Work Flexibility Part time, temporary, teleworking,

shift work, job rotation

Physical work environment

hazards at work

Psycho social work environment

education, job control, job demand,

social networks

Work life balance Commuting, work hours,

care of others, healthy behaviour

physical hazards, accidents,

chemical / biological exposure

perceived job insecurity, job satisfaction,

intimidation / bullying, violence, pressure/

demand/control; OSH training

nicotine, alcohol, drug consumption,

exercise, medical care

Physical, psychological and social well-being mortality, morbidity, disability, musculoskeletal disorders, psychosomatic diseases - stress, depression, burn-out

Source: EPHIA, 2004

Main Populations Main Populations AffectedAffected

Majority of health impacts likely Majority of health impacts likely to affect:to affect:

Construction workforce Construction workforce and and associated associated camp followers camp followers (4,000 (4,000 workers and between 8,000-workers and between 8,000-16,000 followers)16,000 followers)

ResettlementResettlement of 6,000 individuals of 6,000 individualsPhoto: Nam Theun 2 Power Company

Additional impacts could be felt by 100,000 individuals living in surrounding area, e.g. Xe Bang Fai river communities

Construction camps: Construction camps: workersworkers

potential risk profilespotential risk profiles Project timing

Construction Reservoir filling

Operation

Environmental health area A B C D E A B C D E A B C D E

Respiratory diseases Vector-related diseases Sexually-transmitted infections Food, water and soil-borne Accidents and injuries Exposure to hazardous materials Nutrition, food source Psychosocial Cultural health practices Health infrastructure and capacity PM system delivery A: Children/infants < 5 years B: Children aged 5-13 years C: Women of reproductive age D: Men aged 14-60 years E: Elderly > 60 years PM – Programme management

Source: Nam Theun 2 HIA report (2004)

Main mitigation and Main mitigation and enhancement opportunities enhancement opportunities identified for construction identified for construction

campscamps1. Measure that improve the

underlying disease burden via improvements in basic sectors housing, water/sanitation, transportation (e.g. dust

control and road safety) communications

Photo: Nam Theun 2 Power Company

Health action planHealth action plan

Evaluating the proposed measures to mitigate and/or Evaluating the proposed measures to mitigate and/or prevent adverse health impacts and promote positive prevent adverse health impacts and promote positive health outcomeshealth outcomes

– Crucial activitiesCrucial activities

– Role and responsibilitiesRole and responsibilities

– Verification methodsVerification methods

– Mechanisms to monitor changes in health statusMechanisms to monitor changes in health status

– Performance indicatorsPerformance indicators

Monitoring & Monitoring & SurveillanceSurveillance

Such as changes in income levels, inflation, unemployment

Socioeconomic Indicators

Such as disease vector densities, concentration of chemical pollutants, and coverage for adequate sanitation

Environmental indicators

Such as infant and child mortality, incidence and prevalence of communicable diseases, changes in nutritional status

Health indicators

*Indicators used to measure and report performance *Verification measures used to ensure compliance with

stated HAP

Determinants of health Determinants of health influenced by transport influenced by transport

activitiesactivitiesTransport assessment criteria

EconomyJourney timesVehicle operating costsJourney time reliabilityScheme costsRegeneration

EnvironmentLocal air qualityNoiseLandscapeBiodiversityHeritageWater

SafetyOccupational / workerCommunitiesVulnerable groups

AccessibilityPedestrians and othersAccess to public transportCommunity severanceHuman mobility

Integration

FixedGenes, sex, aging

Access to servicesEducationHealth care servicesTransportSocial servicesLeisure

Environment / SettingAir qualitySocial environmentHousing / HomeWater-QualityWork place

LifestyleDietPhysical ActivitySmoking, alcohol, drugsSexual behaviour

Social / EconomicPovertySocial ExclusionEmployment

Factors affecting health

Economic employment

Access to services

Community regeneration

Social / mental well-being

Air Quality

Noise

Well Being

Accidents

Physical Activity

Community Severance

Inequality

Effects on healthfrom transport

Transport assessment criteria

EconomyJourney timesVehicle operating costsJourney time reliabilityScheme costsRegeneration

EnvironmentLocal air qualityNoiseLandscapeBiodiversityHeritageWater

SafetyOccupational / workerCommunitiesVulnerable groups

AccessibilityPedestrians and othersAccess to public transportCommunity severanceHuman mobility

Integration

FixedGenes, sex, aging

Access to servicesEducationHealth care servicesTransportSocial servicesLeisure

Environment / SettingAir qualitySocial environmentHousing / HomeWater-QualityWork place

LifestyleDietPhysical ActivitySmoking, alcohol, drugsSexual behaviour

Social / EconomicPovertySocial ExclusionEmployment

Factors affecting health

Economic employment

Access to services

Community regeneration

Social / mental well-being

Air Quality

Noise

Well Being

Accidents

Physical Activity

Community Severance

Inequality

Effects on healthfrom transport

Economic employment

Access to services

Community regeneration

Social / mental well-being

Air Quality

Noise

Well Being

Accidents

Physical Activity

Community Severance

Inequality

Economic employment

Access to services

Community regeneration

Social / mental well-being

Air Quality

Noise

Well Being

Accidents

Physical Activity

Community Severance

Inequality

Effects on healthfrom transport

(Watkiss et al, 2003 )

Policy context of HIAPolicy context of HIA

WHO influenceWHO influence European UnionEuropean Union

– Article 152, Treaty of Amsterdam, 1999Article 152, Treaty of Amsterdam, 1999– EC Strategic Environmental Assessment Directive, 2001EC Strategic Environmental Assessment Directive, 2001– EC Public Health Strategy, 2002-2007EC Public Health Strategy, 2002-2007

Europe – Protocol for Strategic Environment Europe – Protocol for Strategic Environment Assessment – 2004.Assessment – 2004.

Growing Growing Consensus on Consensus on Inter-sectoral Inter-sectoral

Action for HealthAction for Health

Amsterdam Treaty Amsterdam Treaty "A high level of health protection "A high level of health protection shall be insured in definition and implementation shall be insured in definition and implementation of all community policies and activities" 1997of all community policies and activities" 1997

Reporting on the Right to Health to the UN Commission Reporting on the Right to Health to the UN Commission on Human Rights on Human Rights

Special rapporteur identified HIA as a means to judge if Special rapporteur identified HIA as a means to judge if governments ensure the right to health when pursuing governments ensure the right to health when pursuing economic development.economic development.

The SEA Protocol: A The SEA Protocol: A frame for SEA Directive frame for SEA Directive

implementationimplementation

Exposure(GIS based)

Health effects(based on dose/response curves)

The tools developed consist of two modules (TEX & HIT) to provide two sets of health-related indicators:

• exposure measurements: TEX operates within ArcGIS and for population groups defined by the users according to different features. TEX calculates the exposure of predefined groups along the scenario duration (from 1 hour to 1 year) of considered case study.

• health effects: HIT calculates attributable mortality or morbidity, relative risk, disease-adjusted life-years, for different age / social groups related to air pollution; output for noise and crashes are also available.

Developing tools for the assessment Developing tools for the assessment of health impacts from transport:of health impacts from transport:

e.g. WHO HEARTS modele.g. WHO HEARTS model

SAMU : agent-based modelling of SAMU : agent-based modelling of pedestrians/cars interactions and pedestrians/cars interactions and

resulting accidentsresulting accidents

Source : Banos, Godara, Lassarre, 2005

Opportunities for PH to be Opportunities for PH to be included into the policy and included into the policy and

decision making in other sectors:decision making in other sectors:

Climate Change mitigation and Climate Change mitigation and adaptation measuresadaptation measures

The economic crisis and willingness The economic crisis and willingness to invest heavily to re-launch the to invest heavily to re-launch the economy solutionseconomy solutions

The move towards green jobsThe move towards green jobs

Change is possible:Change is possible:Contributing to change in social normsContributing to change in social norms::

“A man who, beyond the age of 26, finds himself on a bus can count himself as a failure”

A European Parliament A European Parliament ResolutionResolution

adopted on 28 February adopted on 28 February 20022002

Stronger integration of health considerations into transport policies, including by carrying out health impact assessment of major transport projects.”

A European Parliament A European Parliament ResolutionResolution

adopted on 28 February adopted on 28 February 20022002

Stronger integration of health considerations into transport policies, including by carrying out health impact assessment of major transport projects.”