Round table: Health in Environmental Impact Assessment: getting serious about primary prevention

Abstract

Abstract There is an increasing awareness in Europe that health is determined largely by factors outside the health sector. Thus, as public policies in all sectors and at different levels of governance may have a significant impact on population health, a new approach for tackling health is needed. Health in All Policies is an approach to public policies across sectors that systematically considers the health implications of decisions, seeks synergies, and optimises them to improve population health and health equity. Therefore, engagement of the health sector in other policies should be a priority within public health. However, it is bound to meet some resistances as it entails new roles in public health practice, bringing some practitioners out of their comfort zone. Implementing the health in all policies agenda on the ground is challenging, and tools such as Health Impact Assessment (HIA) are needed to enable policy-makers to predict and govern the consequences of their proposals on the well-being of the affected population, and to optimise them. Advocacy and support from the public health sector are imperative to achieve these goals. This also means placing public health professionals outside their usual area of expertise, confronted with alien sectors such as urban planning or infrastructure development. HIA expertise and capacity are still scarce and unevenly distributed in Europe. Indeed, lack of awareness, capacities and resistance from public health officials are usually cited as some of the barriers preventing its establishment as a field of work in many countries. To deal with this problem, many countries and subnational entities have been developing resources such as databases and websites, while others have embarked on capacity building. As a result, there has been a widespread use of HIA in Europe in recent years and sharing some successful case studies is important. The WHO Europe Regions for Health Network (RHN) aims at documenting and disseminating best practices to improve populations’ health across Europe. Andalusia (Spain), through its Regional Ministry of Health, has been implementing HIA over the last five years, focusing on the development of tools and procedures, identifying elements of success, conflicts and reluctances, and windows of opportunity. This workshop is intended to share the existing experiences on HIA and to launch a new RHN case-study publication collecting best practices on HIA across Europe. After an introduction by the chairperson, a presentation by WHO will provide an overview of HIA in Europe, followed by a representative from Andalusia who will focus on the challenges and opportunities found in implementing HIA as a stand-alone document partially integrated with Environmental Impact Assessment procedures. The presentations will be followed by a panel discussion with panelists representing the subnational level of governance, from 5 different countries in Europe: Belgium, Germany, Russian Federation, Spain, Switzerland. Key messages HIA is a tool for implementation of the health in all policy agenda; a resource for addressing complex environmental health determinants and a way of being faithful to WHO’s definition of health. HIA can be simple, if needed. In HIA, too, the best is the enemy of the good. It “operates deliberately in imperfection” as in many cases where stakes are high, decisions urgent and evidence uncertain.