Abstract
Traditional methods of risk assessment have provided good service in support of policy, mainly in relation to standard setting and regulation of hazardous chemicals or practices. In recent years, however, it has become apparent that many of the risks facing society are systemic in nature – complex risks, set within wider social, economic and environmental contexts. Reflecting this, policy-making too has become more wide-ranging in scope, more collaborative and more precautionary in approach. In order to inform such policies, more integrated methods of assessment are needed. Based on work undertaken in two large EU-funded projects (INTARESE and HEIMTSA), this paper reviews the range of approaches to assessment now in used, proposes a framework for integrated environmental health impact assessment (both as a basis for bringing together and choosing between different methods of assessment, and extending these to more complex problems), and discusses some of the challenges involved in conducting integrated assessments to support policy.Integrated environmental health impact assessment is defined as a means of assessing health-related problems deriving from the environment, and health-related impacts of policies and other interventions that affect the environment, in ways that take account of the complexities, interdependencies and uncertainties of the real world. As such, it depends heavily on how issues are selected and framed, and implies the involvement of stakeholders both in issue-framing and design of the assessment, and to help interpret and evaluate the results. It is also a comparative process, which involves evaluating and comparing different scenarios. It consequently requires the ability to model the way in which the influences of exogenous factors, such as policies or other interventions, feed through the environment to affect health. Major challenges thus arise. Chief amongst these are the difficulties in ensuring effective stakeholder participation, in dealing with the multicausal and non-linear nature of many of the relationships between environment and health, and in taking account of adaptive and behavioural changes that characterise the systems concerned.
Highlights
Environmental effects on health have always been multifacetted
Its purpose is to set out clearly and unequivocally the policy question or problem that needs to be addressed, and to agree the scope of the assessment – to set the boundaries of the problem, decide what elements of it are important and what are not, and to outline the policy scenarios that should be considered
Design The purpose of the design stage is to convert the conceptual model devised during issue framing into a detailed protocol for assessment. Often this will involve reconfiguring the initial representation of the system into a more organised structure, that better matches the analytical procedures that need to be undertaken – e.g. by defining clearly the key variables and their relationships, the directions of effect, relevant contextual or confounding factors, and the specific metrics that will be computed during the assessment
Summary
Environmental effects on health have always been multifacetted. Even when the immediate causes have been specific and clear, and the health outcomes limited, as in the case of many natural hazards or chemical contaminants, their origins typically have had deeper and more farreaching roots. Environmental Health 2008, 7:61 http://www.ehjournal.net/content/7/1/61 being used, each with the potential to change the environment more extensively and radically. Another is the increased globalisation and connectedness of societies, as a result of which impacts are not restricted to those locally and immediately involved, but are felt more extensively – in terms of economic and social effects as well as health, on people far-removed from the origin of the hazard, and even on future generations. Many modern environmental threats to health are examples of what have been termed systemic risks [2,3]: complex risks to health embedded in wider environmental, social, economic and political systems.
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