Comprehensive Health Impact Assessment Research Articles

Migration analysis and health impact assessment of phthalates in takeaway food packaging materials

AbstractPlasticizers are commonly utilized as packaging additives in the food service industry. The takeaway food sector provides convenience to consumers, but also raises the risk of human exposure to plasticizers. The goal of this study is to determine the amount of phthalates in takeaway food packaging and compare the migration amounts under various situations. A comprehensive health impact assessment of phthalates was conducted to provide the evaluation of human's daily exposure to phthalates. The results revealed that five phthalates (di (2‐ethylhexyl) phthalate (DEHP), butyl benzyl phthalate (BBP), diethyl phthalate (DEP), dimethyl phthalate (DMP), dibutyl phthalate (DBP)) could be detected in n‐hexane extract of plastic food packaging materials at room temperature. High amount of phthalates was correlated with high temperature or in an oily food simulant solvent. Phthalate contents in dietary exposure did not surpass the concentration that could represent a risk to human health, based on the dietary exposure evaluation.

Methodology for a Comprehensive Health Impact Assessment in Water Supply and Sanitation Programmes for Brazil.

Based on the broader concept of health proposed by the Pan-American Health Organization/World Health Organization (PAHO/ WHO), 2018, and the absence in the literature of indices that translate the causal relationship between sanitation and health, a methodology for assessing the health impact of a water and sanitation programmes, known as a Health Impact Assessment (HIA), was developed, specifically in the Brazilian context, and focused on a school in the northeast of the country. Through exploratory and descriptive evidence, and using documentary research as a method, a retrospective survey was carried out from 2000 to 2022 using documents proposing evaluation methodologies. A single document was found to fit the research objective, which was used to develop the proposed HIA methodology. Development of the methodology consisted of two stages: definition of the health dimensions and selection of the indicators making up each dimension. The HIA methodology was then applied to a school in northeast Brazil to test its use, before a water-efficient management intervention was going to be used. The overall score of 46% indicated that there was room for improvement, which the new management approach could facilitate. This methodology is therefore proposed to be an instrument for the evaluation of public water and sanitation policies, thus assisting managers in the decision-making process and in guiding sanitation programs and plans.

Evaluating Racial/Ethnic Equity in Planning-Related U.S. Health Impact Assessments Involving Parks and Greenspaces

Problem, research strategy, and findings Health impact assessment (HIA) reports are used by government agencies, other organizations, and stakeholders to evaluate potential health effects of plans/policies/projects. HIAs have the potential to promote anti-racist practices. We developed and used the Tool for the Racial/Ethnic Equity Evaluation of Health Impact Assessments (TREE-HIA) to score 50 U.S. HIA reports on planning-related projects/plans involving parks and greenspaces (2005–2020). More recent and more comprehensive HIA reports addressed racial/ethnic equity to a greater degree (e.g., median TREE-HIA scores: −1.3 in 2009–2012, 4.0 in 2017–2020, where higher scores indicate greater racial/equity considerations). Overall, HIA reports addressed racial/ethnic equity to a lesser degree than expected given the principal tenet of equity guiding HIAs and urban planning alike (42% had negative TREE-HIA scores indicating inadequate racial/ethnic equity consideration). However, the limited number and types of HIAs included in this study may affect generalization to all HIAs. Takeaway for practice HIAs incorporating racial/ethnic equity comprehensively throughout the HIA process will better enable urban planners, HIA practitioners, decision makers, and communities of color to work together to combat racist planning practices through the shared goals of addressing health disparities and equity. TREE-HIA provides professionals and researchers with a brief tool that can be used/adapted to guide and evaluate future HIAs for racial/ethnic equity considerations.

Economic change and population health: lessons learnt from an umbrella review on the Great Recession

ObjectivesWorldwide, the COVID-19 pandemic triggered the sharpest economic downturn since the Great Recession. To prepare for future crises and to preserve public health, we conduct an overview of systematic reviews...

Health impact assessment of a mining project in Swedish Sápmi: lessons learned

ABSTRACT Whereas assessing health is a mandatory feature of environmental impact assessments (EIAs) in Sweden, health impacts are often vaguely described, making their health preventive role meaningless. In 2006, a mine was planned in the reindeer grazing lands of a Sámi community in northern Sweden. While an EIA was conducted in 2013, health was superficially addressed. The aim of this study was to describe and reflect on the health impact assessment (HIA) process that assessed the potential health risks and/or benefits that the mine establishment could bring to the Sámi community. The classic five steps of an HIA are presented. The literature review showed a scarcity of studies regarding HIA on mining in indigenous territories. Participants in the study were currently experiencing negative psychosocial health effects and described potential adverse social and health effects originating from the loss of their traditional way of life. Despite certain challenges, this study proved that it is possible to conduct a comprehensive HIA in the context of Sámi health research. Given that mining in Sweden occurs mostly in Sámi territory and the adverse health effects found in this study, the lack of comprehensive HIAs on mining projects in Sweden raises serious concerns.

Health Impact Assessments of Health Sector Proposals: An Audit and Narrative Synthesis.

Background: Health impact assessment (HIA) is a tool used to assess the potential health impacts of proposed projects, programs, and policies. The extent of the use of HIAs conducted on health sector proposals, and what they focus on, is currently largely undocumented. This paper reviews HIAs conducted on health sector proposals, their characteristics and describes the settings in which they were conducted. Methods: A systematic review was conducted, including peer-reviewed journals and grey literature utilizing keywords, synonyms, and subject headings relevant to HIA and the health sector. Eligibility criteria were independently applied to the identified works and data appraisal conducted using the Critical Appraisal Skills Programme qualitative checklist tool. Results: 19 HIAs were identified and included in the review, including 13 rapid, three intermediate, and two comprehensive HIAs. The HIAs use was evident across a range of health service contexts, though all but one had been conducted in developed countries. Conclusion: The use of HIAs in the health sector is limited. There were various benefits attributed to the HIAs analysed including and not limited to the allocation of resources, reducing inequalities, and identification of possible negative consequences of a project. There is an opportunity to improve the use and reporting of HIAs across health settings internationally to enhance the consideration of broader determinants of health, influence decision making, and use of evidence in health sector planning for the future.

Tackling social inequalities in health: acceptability and feasibility of a systematic approach toward health impact assessment of urban projects.

The general objective of this research project was to explore the feasibility and acceptability of an original method intended to systematically identify urban planning projects whose potential impacts on health and social inequalities in health (SIH) would be most damaging. An approach based on a short meeting and a tool would help to discuss whether or not to engage in a more comprehensive health impact assessment. A tool was developed by the research team based on various tools reported in the literature and modified with urban planners. Meetings were organized for each development project with the volunteer planners, who were working on the projects selected. Reviews of six projects at different stages of design made it possible to assess the acceptability and feasibility of this approach to identify public health and social equity issues in health. The process and the use of the tool were found to be feasible. The tool was easily understandable, adapted to the practices of planners and usable without real training other than a quick introduction to tool usage. It was also found to be acceptable. Despite an interest in the inclusion of SIH, the integration of the relationship between SIH and urban development was not easy for most of the urban planners. This exploratory work suggests that a systematic approach to assessing the impact of urban projects on health and SIH is feasible and acceptable. Dealing with SIH was not found to be easy by the urban planners.

The Public Health Implications of Brexit in Wales: A Health Impact Assessment (HIA) approach

Abstract On March 29th 2019, the United Kingdom was due to exit the European Union (EU) in a process known informally as ‘Brexit’. The 2 years before this time (and ongoing) experienced a period of unprecedented political and social upheaval with many unknowns and much uncertainty attached to the outcomes and future impact of withdrawal and transitionary period. Public Health Wales commissioned the Wales Health Impact Assessment (HIA) Support Unit to carry out a HIA of Brexit in Wales to assess the potential impact, extent and nature of ‘Brexit’ on health and wellbeing in Wales which would to inform its planning, future work and support other bodies decision-making, planning and policymaking. A comprehensive HIA was conducted over a 6 month period in 2018/19, steered by a Strategic Advisory Group. Methods included; a literature review; stakeholder workshop; interviews with policy leads, a community health profile, and report with evidence synthesis. Trade agreements, economic impacts, changing relationships with EU agencies, uncertainty and loss of regulatory alignment were key pathways for health impacts to occur. Potential impacts included; food standards/safety; environmental regulations; working conditions; and health and social care. Many impacts will affect the whole population. Vulnerable populations included; children/young people; those at risk of unemployment;Welsh areas receiving significant EU funding. Potential indirect impacts were identified on mental well-being. Brexit has the potential to impact significantly on the determinants of health.The HIA has informed and influenced cross-sector planning and policy in response to the short/long-term implications of Brexit to ensure that health and inequalities are considered at every juncture.This unique work demonstrates continued leadership by Wales in the field of impact assessment and ‘health in policies’ and has been positively received. It has transferable learnings for many nation states and health policy leads. Key messages Brexit is a major policy change with major health impacts. HIA is an informative and influencing process to support planning and future policy making.

Risk-Benefit Assessment of Foods.

Food is an elementary requirement for human life, providing nutrients and essential energy needed for optimal health. But at the same time, food can also be a vehicle of hazardous substances or pathogens that could affect human health negatively. Risk‐benefit assessment (RBA) of foods, a relatively new methodology for decision support, integrates nutrition, toxicology, microbiology, chemistry and human epidemiology for a comprehensive health impact assessment. By integrating health risks and benefits related to food consumption, RBA facilitates science‐based decision‐making in food‐related areas and the development of policies and consumer advice. The present work programme aimed to allow the fellow to become acquainted with the process of RBA and the associated tools needed to assess quantitatively the risks and the benefits through three main activities (i) to learn the different methodologies used for RBA; (ii) to apply these methodologies to a specific case‐study – RBA of raw milk consumption; and (iii) to participate in the main activities of the Risk‐Benefit research group at DTU Food regarding risk‐benefit issues. For the RBA of raw milk consumption, microbiological pathogens (Listeria monocytogenes, Salmonella spp., Campylobacter jejuni and Shiga toxin‐producing Escherichia coli), probiotic bacteria and nutritional components (vitamins B2 and A) were considered, as well as the potential impact of raw milk consumption in the reduction of the allergies’ prevalence. Two major approaches were applied: the bottom‐up (estimating the disease incidence due to the exposure) and the top‐down (using epidemiological and incidence data to the estimate the number of cases attributable to a certain exposure). Through all the training and hands‐on activities performed, the present work programme enabled the fellow to extend the knowledge on the quantitative RBA, specifically in the context of raw milk consumption. EU‐FORA programme also provided an exceptional opportunity of networking and establishment of future research lines of collaboration.

Selected indicators and determinants of women\u2019s health in the vicinity of a copper mine development in northwestern Zambia

BackgroundLarge projects in the extractive industry sector can affect people’s health and wellbeing. In low- and middle-income countries (LMICs), women’s health is of particular concern in such contexts due to potential educational and economic disadvantages, vulnerability to transactional sex and unsafe sex practices. At the same time, community health interventions and development initiatives present opportunities for women's and maternal health.MethodsWithin the frame of the health impact assessment (HIA) of the Trident copper mining project in Zambia, two health surveys were conducted (baseline in 2011 and follow-up in 2015) in order to monitor health and health-related indicators. Emphasis was placed on women residing in the mining area and, for comparison, in settings not impacted by the project.ResultsAll measured indicators improved over time, regardless of whether communities were affected by the project or not. Additionally, the percentage of mothers giving birth in a health facility, the percentage of women who acknowledge that HIV cannot be transmitted by witchcraft or other supernatural means and the percentage of women having ever tested for HIV showed a significant increase in the impacted sites but not in the comparison communities. In 2015, better health, behavioural and knowledge outcomes in women were associated with employment by the project (or a sub-contractor thereof), migration background, increased wealth and higher educational attainment.ConclusionsOur study reveals that natural resource development projects can positively impact women’s health, particularly if health risks are adequately anticipated and managed. Hence, the conduct of a comprehensive HIA should be a requirement at the feasibility stage of any large infrastructure project, particularly in LMICs. Continued monitoring of health outcomes and wider determinants of health after the initial assessment is crucial to judge the project’s influence on health and for reducing inequalities over time.

Comprehensive Health Impact Assessment for Active Travel: The "Pasta" Project Approach

PASTA (Physical-Activity-through-Sustainable-Transport-Approaches) is a European project that aims to promote and assess active travel and develops a new comprehensive Health Impact Assessment (HIA) model for active travel (AT). Objective: Describe the HIA approach used in the PASTA project. Conduct workshops and individual interviews with experts and stakeholders in seven study cities (Antwerp, Barcelona, London, Orebro, Rome, Vienna, and Zurich). Conduct a systematic review (SR) on active travel HIA, and cost benefits analysis. Quantify health and environmental risks and benefits related with AT interventions and assess the uncertainties. Report and communicate the results to stakeholders, experts and citizens. The workshops and interviews showed their importance to identify: 1) the main policies on AT; 2) the priorities and expectations of HIA in the decision-making process; 3) data sources; and 4) key stakeholder-networks for participation and dissemination. The SR showed research gaps in: 1) identification and quantification of health determinants of AT (e.g. physical activity, traffic hazards, air pollution, etc.); 2) selection relative risks based on the weight of evidence; 3) harmonization of methods, definitions and assumptions used; and 4) the close collaboration between urban planners, transport practitioners and health experts. The novel mixed methods approach of integrating stakeholder and expert workshops, interviews, systematic reviews and evidence-based approaches in the HIA process are necessary advancements for comprehensive HIA of AT.

Comprehensive Health Impact Assessment for Active Travel: the

Introduction: PASTA (Physical-Activity-through-Sustainable-Transport-Approaches) is a European project that aims to promote and assess active travel and develops a new comprehensive Health Impact Assessment (HIA) model for active travel (AT). Methods: Conduct workshops and individual interviews with experts and stakeholders in seven study cities (Antwerp, Barcelona, London, Orebro, Rome, Vienna, and Zurich). Conduct a systematic review (SR) on active travel HIA, and cost benefits analysis. Quantify the health risk and benefits related with AT interventions and assess the uncertainties. Report and communicate the results to stakeholders, experts and citizens. Results: The workshops and interviews showed their importance to identify: 1) the main policies on AT; 2) the priorities and expectations of HIA in the decision-making process; 3) data sources; and 4) key stakeholder-networks for participation and dissemination. The SR showed research gaps in: 1) identification and quantification of health determinants of AT (e.g. physical activity, traffic hazards, air pollution, etc.); 2) selection relative risks based on the weight of evidence; 3) harmonization of methods, definitions and assumptions used; and 4) the close collaboration between urban planners, transport practitioners and health experts. Conclusions: The novel mixed methods approach of integrating stakeholder and expert workshops, interviews, systematic reviews and evidence-based approaches in the HIA process are necessary advancements for comprehensive HIA of AT.

The hidden economic burden of air pollution-related morbidity: evidence from the Aphekom project.

Public decision-makers commonly use health impact assessments (HIA) to quantify the impacts of various regulation policies. However, standard HIAs do not consider that chronic diseases (CDs) can be both caused and exacerbated by a common factor, and generally focus on exacerbations. As an illustration, exposure to near road traffic-related pollution (NRTP) may affect the onset of CDs, and general ambient or urban background air pollution (BP) may exacerbate these CDs. We propose a comprehensive HIA that explicitly accounts for both the acute effects and the long-term effects, making it possible to compute the overall burden of disease attributable to air pollution. A case study applies the two HIA methods to two CDs-asthma in children and coronary heart disease (CHD) in adults over 65-for ten European cities, totaling 1.89 million 0-17-year-old children and 1.85 million adults aged 65 and over. We compare the current health effects with those that might, hypothetically, be obtained if exposure to NRTP was equally low for those living close to busy roads as it is for those living farther away, and if annual mean concentrations of both PM10 and NO2-taken as markers of general urban air pollution-were no higher than 20μg/m3. Returning an assessment of € 0.55 million (95% CI 0-0.95), the HIA based on acute effects alone accounts for only about 6.2% of the annual hospitalization burden computed with the comprehensive method [€ 8.81 million (95% CI 3-14.4)], and for about 0.15% of the overall economic burden of air pollution-related CDs [€ 370 million (95% CI 106-592)]. Morbidity effects thus impact the health system more directly and strongly than previously believed. These findings may clarify the full extent of benefits from any public health or environmental policy involving CDs due to and exacerbated by a common factor.

Health Impact Assessment of an oil drilling project in California

The Health Impact Assessment (HIA) was conducted to evaluate the potential community health implications of a proposed oil drilling and production project in Hermosa Beach, California. The HIA considered 17 determinants of health that fell under 6 major categories (i.e., air quality, water and soil quality, upset conditions, noise and light emissions, traffic, and community livability). This paper attempts to address some of the gaps within the HIA practice by presenting the methodological approach and results of this transparent, comprehensive HIA; specifically, the evaluation matrix and decision-making framework that have been developed for this HIA and form the basis of the evaluation and allow for a clear conclusion to be reached in respect of any given health determinant (i.e., positive, negative, neutral). There is a number of aspects of the project that may positively influence health (e.g., increased education funding, ability to enhance green space), and at the same time there have been potential negative effects identified (e.g., odor, blowouts, property values). Except for upset conditions, the negative health outcomes have been largely nuisance-related (e.g., odor, aesthetics) without irreversible health impacts. The majority of the health determinants, that had been examined, have revealed that the project would have no substantial effect on the health of the community. Using the newly developed methodology and based on established mitigation measures and additional recommendations provided in the HIA, the authors have concluded that the project will have no substantial effect on community health. This approach and methodology will assist practitioners, stakeholders and decision-makers in advancing the HIA as a useful, reproducible, and informative tool.

A13 Comprehensive Health Impact Assessment for Active Travel: A "PASTA" project approach

Abstract Background Health impact assessment (HIA) is a combination of methods by which a policy or intervention may be assessed and judged for its potential effects on the health of the population. The HIA is classified in four levels of depth: desk-based, rapid, intermediate and comprehensive. These different levels vary in resources, capacity, duration and level of health impacts. Comprehensive HIA is the more complex, collecting and analyzing data from different sources. It also offers more accurate estimates of the health impacts related with multiple pathways and health determinants. PASTA (Physical Activity through Sustainable Transport Approaches) is a European project with detailed case studies in seven cities (Antwerp, Barcelona, London, Orebro, Rome, Vienna and Zurich) that focuses on promoting and assessing active travel and developing a new comprehensive health impact assessment (HIA) model for active transport. Methods Identifying stakeholders and experts in each city. conduct workshops (one in each city) with stakeholders and experts. Perform individual interviews (12 in each city) with experts and stakeholders. Conduct a systematic review on active travel HIA, risk assessments and cost benefits analysis published in peer review journals. Conduct systematic reviews to identify the most robust epidemiological evidence between health exposures and outcomes. Build a HIA model quantifying the health risk and benefits related with active travel interventions and measure the uncertainties. Report and communicate the results to stakeholders, experts and citizens. Results The workshops and interviews showed their importance to identify 1) main interventions or policies on active travel in the local context; 2) the requirements, priorities and expectations of HIA in the decision making process; 3) local and regional data sources; and 4) key stakeholder networks for participation and dissemination. The systematic review of HIA showed that there is further improvement needed in 1) the identification and quantification of health determinants (e.g. physical activity, traffic hazards, air pollution, noise, etc.); 2) selection of robust dose-response functions based on the weight of evidence; 3) the harmonization of methods, definitions and assumptions used; and 4) the close collaboration between urban planners, transport practitioners and health experts. Conclusions The novel approach of integrating stakeholder and expert workshops, interviews, systematic reviews and evidence based approaches in the HIA process is a necessary advancement for comprehensive HIA for active travel.

The Trans-Pacific Partnership Agreement: Trading away our health?

There is long-standing interest by the public health community in the potential implications of trade and investment agreements for public health. Our commentary highlights the main pathways by which the Trans-Pacific Partnerships (TPP), a comprehensive trade and investment agreement currently under negotiation, might undermine population health (based on analysis of and commentary about leaked chapters of the TPP), and calls for a more transparent and health-sensitive TPP negotiation process. We argue that use of comprehensive health impact assessments could be helpful in identifying how the potentially serious health consequences of the TPP and similar future international trade and investment agreements can be avoided, minimized or mitigated.

Shale Gas Extraction in North Carolina: Research Recommendations and Public Health Implications

Shale Gas Extraction in North Carolina: Research Recommendations and Public Health Implications

Is Shale Gas Drilling an Energy Solution or Public Health Crisis?

High-volume horizontal hydraulic fracturing, a controversial new mining technique used to drill for shale gas, is being implemented worldwide. Chemicals used in the process are known neurotoxins, carcinogens, and endocrine disruptors. People who live near shale gas drilling sites report symptoms that they attribute to contaminated air and water. When they seek help from clinicians, a diagnosis is often elusive because the chemicals to which the patients have been exposed are a closely guarded trade secret. Many nurses have voiced grave concern about shale gas drilling safety. Full disclosure of the chemicals used in the process is necessary in order for nurses and other health professionals to effectively care for patients. The economic exuberance surrounding natural gas has resulted in insufficient scrutiny into the health implications. Nursing research aimed at determining what effect unconventional drilling has on human health could help fill that gap. Public health nurses using the precautionary principle should advocate for a more concerted transition from fossil fuels to sustainable energy. Any initiation or further expansion of unconventional gas drilling must be preceded by a comprehensive Health Impact Assessment (HIA).

Integrated health impact assessment of travel behaviour: Model exploration and application to a fuel price increase

Transportation policy measures often aim to change travel behaviour towards more efficient transport. While these policy measures do not necessarily target health, these could have an indirect health effect.We evaluate the health impact of a policy resulting in an increase of car fuel prices by 20% on active travel, outdoor air pollution and risk of road traffic injury. An integrated modelling chain is proposed to evaluate the health impact of this policy measure. An activity-based transport model estimated movements of people, providing whereabouts and travelled kilometres. An emission- and dispersion model provided air quality levels (elemental carbon) and a road safety model provided the number of fatal and non-fatal traffic victims. We used kilometres travelled while walking or cycling to estimate the time in active travel. Differences in health effects between the current and fuel price scenario were expressed in Disability Adjusted Life Years (DALY).A 20% fuel price increase leads to an overall gain of 1650 (1010–2330) DALY. Prevented deaths lead to a total of 1450 (890–2040) Years Life Gained (YLG), with better air quality accounting for 530 (180–880) YLG, fewer road traffic injuries for 750 (590–910) YLG and active travel for 170 (120–250) YLG. Concerning morbidity, mostly road safety led to 200 (120–290) fewer Years Lived with Disability (YLD), while air quality improvement only had a minor effect on cardiovascular hospital admissions. Air quality improvement and increased active travel mainly had an impact at older age, while traffic safety mainly affected younger and middle-aged people.This modelling approach illustrates the feasibility of a comprehensive health impact assessment of changes in travel behaviour. Our results suggest that more is needed than a policy rising car fuel prices by 20% to achieve substantial health gains. While the activity-based model gives an answer on what the effect of a proposed policy is, the focus on health may make policy integration more tangible. The model can therefore add to identifying win–win situations for both transport and health.

PSS22 A Comprehensive Health Impact Assessment and Determinants of Quality of Life, Health and Psychological Status in Acne Patients

PSS22 A Comprehensive Health Impact Assessment and Determinants of Quality of Life, Health and Psychological Status in Acne Patients