Dr Salim Vohra: Centre For Health Impact Assessment, Institute Of Occupational Medicine

Health Impact Assessment as a key approach to tackling health inequalities

Dr Salim Vohra Centre for Health Impact Assessment, Institute of Occupational Medicine Presentation 30th September 2008

Environment & health in context: housing conditions

a complex web of factors personality

Biological factors

genetic factors sex

leisure activities

noise

soil quality

air quality

Environment

green space

Lifestyle

family relationships

alcohol

employment status working condition

Personal circumstances

medication

income

illegal substances

personal transport

education

social support

community participation

water quality

public & environmental health services

waste management

smoking

diet

age

smell

natural hazards

sexual behaviour

disability

ethnicity

housing tenure

social contact

Determinants of

Health & Wellbeing

natural resources

peer pressure

Social influences

land use & planning

discrimination

crime & anti-social behaviour

fear of discrimination

fear of crime & anti-social behaviour

research & technological development business activity

Economic conditions

availability and quality of employment

availability and quality of training

job creation distribution of incomes

childcare

voluntary & charity groups health & social care services shops and banking services

community facilities

Availability & access

public transport

Adapted from ‘Rapid Health Impact Assessment: a guide to research’ by Amanda Harris, 2002

advice services

leisure facilities housing education & training

Or put another way!

Since I came to the White House I got two hearing aids, a colon operation, skin cancer, a prostate operation and I was shot. The damn thing is, I never felt better in my life.

Or even another way!

“Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity… …Health is therefore a resource for everyday life, not the objective of living; it is a positive concept emphasizing social and personal resources, as well as physical capacities.” World Health Organization, 1947 and 1984.

Difference in smoking lung cancer deaths in three social groups and the west of Scotland 500

West of Scotland 400

Average

300

American Cancer

annual

UK doctors

Society volunteers

death rate /100,000

200

US veterans

100

0 0

10

20

30

40

Average number of cigarettes smoked daily Source: Dr Harry Burns

The role of health care and the wider determinants of health

Health Impact Assessment 1. Health impact assessment is the systematic prediction of the potential positive and negative health and wellbeing impacts of new policies, plans, programmes and projects (proposals), including how these impacts are distributed across the population. 3. It also generally provides a set of recommendations and/ or a set of mitigation and enhancement measures so that positive health impacts are maximised and negative health impacts minimised within a given population. 5. HIA is therefore about both protecting health, by reducing exposures to harmful agents as well as, improving health by capitalising on opportunities to promote and enhance health and wellbeing. 7. HIA is focused on tackling health inequalities generated by the uneven distribution of health impacts within an affected population. 9. HIA informs decision-makers so that they can ‘health proof’ their decisions

How it all fits together

Health Impact Assessment

Cartoon by Simon Kneebone, published by Fran Baum (2007), IIJHP&E,XIV, 2, 90-95

HIA in the UK, WHO Health Cities & Healthy Urban Planning •

UK leading HIA country, recognised as such internationally

•

HIA seen as good practice nationally and locally

•

Strong bottom up approach to use of HIA

•

WHO Commission on the Social Determinants of Health advocates the use of Health (Equity) Impact Assessment

•

Marmot Commission in England looking at how this work can be put into practice in England

•

WHO Healthy Cities latest work programme has HIA at its heart

•

WHO writing an international good practice guide to HIA

•

Health and planning links increasingly being recognised by RTPI, CABE, National Heart Foundation, Natural England, RSPB, …

The Streetcar Project Quality Buses

The Streetcar Project Network & Street Improvements

The Streetcar Project The Route

Health Impacts of the Streetcar Project CONTEXTUAL FACTORS THAT INFLUENCE WALKING AND BUS USE Access to high number of local shops and amenities along/near bus route

Neighbourhood attractiveness (including greenspace)

ASSUMPTIONS Key users groups to consider: •Children •Women •Older people •Ethnic minorities •People with disabilities

Bus Rapid Transport Scheme

No or weak evidence

Reasonable or strong evidence Positive impact Negative impact

Reduction in journey times

Neighbourhood disorder and safety: physical dereliction, crime and incivilities, perceived safety, policing levels

Neighbourhood walkability: residential density, land use mix, street connectivity and way-finding

Decrease in fossil fuel use Reduction in car usage and cars on road

Levels of traffic and road safety and pedestrian infrastructure e.g. crossings, traffic calming

Reduce climate change effects

Decrease in air pollution

Improvement in mental health and wellbeing

Decrease in noise pollution Decrease in vehicle collisions Improve traffic flow

Increase in walking to and from bus stops

Improvement in journey comfort

Quality of buses and related infrastructure e.g. bus shelters, real time information

Improved access to key services/ and amenities along the route e.g. route goes through hospital

Uncertain impact Public transport availability, accessibility, affordability and ease of use

Increase in bus patronage (Streetcar Scheme & overall)

Increase in exposure to the outdoors

Improved accessibility to amenities

Make cycling/walking more attractive Increase in long term physical activity Increase in short term physical activity

Decrease in obesity

Increase in exposure to air pollution

Decrease in diabetes Increase in interaction with greenspace and public openspace

Increase in income Increase in educational achievement Increase in house prices along route Enhance neighbourhoods along route Enhance wider local economy

Increase in civic pride

Social support: supportive family, peers and community

Decrease in exacerbations of respiratory conditions Decrease in some cancers Decrease in osteoporosis

Increase in social capital and community cohesion Increase, decrease or no change in actual or perceived crime/ incivilities

Improved image of Stoke

Decrease in cardiovascular disease

Increase in cultural capital

Improved access to: Entertainment, eating & drinking venues Arts and leisure facilities Health & social care services Education & employment opportunities Family & friends

Increase in interactions with other people

Personal preference, motivation and intention to walk and use bus

Improvement in physical fitness and functioning

Poverty, disability not having access to a car and weather

Commute time and travel plans in school, hospital and workplaces. Road safety education in schools.

CONTEXTUAL FACTORS THAT INFLUENCE WALKING AND BUS USE

Decrease in traffic related injuries and falls in older people

Social/public health marketing on the benefits of using bus services

Recommendations of the Streetcar HIA •HIA report part of the Streetcar Business Case for Funding •Linking Street Improvements along the route with wider environmental/greening improvements along the Streetcar route •Use of all electric or hybrid low emission buses •Design of buses to include disabled and pushchair access (including need to have some level of noise form the bus engines for blind pedestrians and bus users) •Building in of maintenance budget for street improvements, realtime passenger information and buses within Business Case •Good communication and consultation plan for the construction/implementation phase

Recommendations of the Streetcar HIA •Enhanced training for Streetcar drivers to deal with people with disabilities •Encourage green travel plans with key organisation along the route •Link into existing physical activity programmes •Set aside a small social marketing budget within the main marketing budget to encourage healthy behaviour change for people from all backgrounds

Part of 4 HIAs Pilot Project •Middleport Regeneration Masterplanning •City Waterside Masterplanning •Leek Town Centre Refurbishment

Aim: Embedding HIA in North Staffordshire through the development of 4 HIAs, learning from these HIAs and the development of healthy urban planning and HIA tools where appropriate.

Helping to improve health and wellbeing

and mainstreaming the use of HIA as a tool for healthy urban planning and project development