Health Impact Assessment Tool Research Articles

Assessment of Mortality Attributable to Air Pollution in the Urban Area of Pisa (Central Italy) Characterized by Multi-Source Exposures

Air pollution is one of the main risk factors for human health. The aim of this study was to provide an Integrated Environmental and Health Impact Assessment (IEHIA) tool to estimate the impacts on both environment and human health in Pisa municipality (central Italy). For each pollutant considered (PM2.5, PM10, and NO2), both Population-Weighted Exposure (PWE) and Attributable Deaths (ADs) were calculated considering the difference between the PWE and the latest air quality guidelines suggested by the World Health Organization. The PWEs were 16.1 µg/m3, 24.9 µg/m3, and 25.9 µg/m3 for PM2.5, PM10, and NO2, respectively. The ADs from natural causes due to exposure to PM2.5, PM10, and NO2 were 63, 29, and 51, respectively. The AD distribution was mainly concentrated in urban areas for particulate matter and in urban and suburban areas for NO2. The results highlighted significantly higher levels of air pollution than the reference levels, with a percentage of ADs from natural causes of approximately 6% of the total mortality in Pisa. IEHIA offers support for environmental and health policies and territorial planning. The authors recommend the adoption of prevention measures aimed at mitigating air pollution in critical areas, with a consequent reduction in avoidable mortality.

DYNAMO-HIA: A health impact assessment tool fit for quantifying tobacco control policy

Abstract DYNAMO-HIA is a generic, publicly-available and easy to use software tool for health impact assessments of changes in health risk-factors such as obesity, air pollution, processed meat consumption, physical activity, alcohol taxation, or smoking. The tool uses a graphic use interface, does not require programming skills, and has comparatively modest data requirements. Health outcomes that can be investigated are mortality, life expectancy, healthy-life expectancy, disability and prevalence of various chronic disease such as chronic obstructive pulmonary disease (COPD), cancer, or coronary heart diseases. DYNAMO-HIA can in principle be used for any tobacco control policy or ordinance-e.g. price increases or pictorial health warning labels-that target changes in smoking prevalence or smoking initiation/quitting rates. Past applications of DYNAMO-HIA for tobacco control policy included country studies for Belgium, Mongolia, or Korea and several comparative country studies. In this presentation we will give a general overview into the use of DYNAMO-HIA and show-case a recently published study. This study quantified the reduction in COPD burden that would occur in Italy, England and Sweden over 40 years if tobacco prices were increased by 5%, 10% and 20% over current local prices.

An Innovative Geospatial Monitoring and Health Impact Assessment Tool for Sustainable and Healthy City Planning

An Innovative Geospatial Monitoring and Health Impact Assessment Tool for Sustainable and Healthy City Planning

Integrating health effects within an agent-based land use and transport model

IntroductionTransport is a determinant of urban health, and the past two decades have seen a rise in transport health impact assessment (HIA) tools. However, a common limitation of HIAs is the use of aggregation which ignores variations over space, time, and/or demographics. Furthermore, HIAs generally treat travel behaviour exogenously, meaning they can assess the effects of hypothetical behaviour shifts but not the policies that cause behaviour to change. MethodsThis article presents an open-source agent-based integrated land use, transport, and health impacts model that assesses health exposures and impacts related to physical activity, air pollution, and traffic injury risk. The agent-based framework allows exposures and impacts to be assessed with high spatiotemporal and sociodemographic resolution. To achieve a tight integration, the model adapts (traditionally car-oriented) transport modelling methods to capture health-relevant behaviours such as active travel more realistically. In addition, exposure modelling methods have been adapted to make use of the high spatial and temporal detail available in agent-based transport models. DemonstrationTo demonstrate this integrated model, this article presents an example simulation which evaluates the health impacts of a work from home policy in Munich. Overall, there is on average a small net health detriment for individuals required to work from home and a smaller net health benefit for everybody else. ConclusionsAgent-based modelling enables HIAs to jointly assess transport, environmental, and population health outcomes with high granularity, helping policymakers identify who benefits and suffers from proposed policies. This work demonstrates the feasibility of combining agent-based transport and health modelling methods in a seamless framework.

How to improve the impact of healthcare campaigns by introducing methods of health impact assessment among students and health professionals

The development of health brigades in vulnerable populations constitutes a fundamental role for the approach of students to clinical practice and allows professionals to attend to basic needs in small and specific populations. Health impact assessment tools are essential to choose the populations and pathologies to study through the implementation of well-defined objectives that reduce the knowledge gap between the clinical and administrative fields of health between students and professionals, and thus, establish a scientific research and monitoring exercise.

The Health Economic Assessment Tool (HEAT) for walking and cycling - experiences from 10 years of application of a health impact assessment tool in policy and practice.

In recent years, walking and cycling have moved into the focus as promising approaches to achieve public health, sustainable transport, climate goals and better urban resilience. However, they are only realistic transport and activity options for a large proportion of the population when they are safe, inclusive and convenient. One way to increase their recognition in transport policy is the inclusion of health impacts of walking and cycling into transport economic appraisals. The Health Economic Assessment Tool (HEAT) for walking and cycling calculates: if x people walk or cycle a distance of y on most days, what is the economic value of impacts on premature mortality, taking into account effects of physical activity, air pollution and road fatalities, as well as effects on carbon emissions. Different data sources were collated to examine how the HEAT in more than 10 years of existence, and to identify lessons learned and challenges. Since its launch in 2009, the HEAT has gained wide recognition as a user friendly, yet robust, evidence-based tool usable by academics, policymakers, and practitioners. Originally designed for use in Europe, it has since been expanded for global use. Challenges for a wider uptake of health-impact assessment (HIA) tools including active transport such as HEAT are the promotion and dissemination to local practitioners and policy makers also outside European and English-speaking regions and in low- and middle-income contexts, further increasing usability, and more generally the advancement of systematic data collection and impact quantification related to walking and cycling.

Impacts of the large-scale use of passenger electric vehicles on public health in 30 US. metropolitan areas

In addition to sound policies at the national level, the successful implementation of zero-emission vehicle goals requires commitments and actions at the regional level. This study quantified what the potential impact would be by 2050 of large-scale use of passenger electric vehicles (EVs) on air pollution (concentrations of fine particulate matter), public health, and associated economic gains across various metropolitan areas in the United States. Results were estimated and reported for 30 metropolitan areas. The study employed the U.S. Environmental Protection Agency CMAQ air quality model and the BenMAP health impact assessment tool. Results indicated that a large-scale uptake in EV passenger travel can improve air quality and reduce mortality. The top five metropolitan areas that would benefit the most from such transportation electrification are Los Angeles (1163 prevented premature deaths annually, corresponding to $12.61 billion health benefits), New York (576, $6.24 billion), Chicago (276, $3.00 billion), the San Joaquin Valley (260, $2.82 billion), and Dallas (186, $2.02 billion). These results provide important scientific input to national and regional policymakers in support of decision-making towards clean transportation. This study examined the status quo and latest updates on EV transition policies across different regions given that California and several northeast states have already expressed explicit clean transportation goals. Interrelated policy, technology, and behavioral measures toward bringing down barriers to EV adoption were also examined. The wide differences that exist in the electricity mix across various regions suggests that varying strategies are needed down the road to achieve clean electric mobility.

ZIP Code-Level Estimation of Air Quality and Health Risk Due to Particulate Matter Pollution in New York City.

Exposure to PM2.5 is associated with hundreds of premature mortalities every year in New York City (NYC). Current air quality and health impact assessment tools provide county-wide estimates but are inadequate for assessing health benefits at neighborhood scales, especially for evaluating policy options related to energy efficiency or climate goals. We developed a new ZIP Code-Level Air Pollution Policy Assessment (ZAPPA) tool for NYC by integrating two reduced form models—Community Air Quality Tools (C-TOOLS) and the Co-Benefits Risk Assessment Health Impacts Screening and Mapping Tool (COBRA)—that propagate emissions changes to estimate air pollution exposures and health benefits. ZAPPA leverages custom higher resolution inputs for emissions, health incidences, and population. It, then, enables rapid policy evaluation with localized ZIP code tabulation area (ZCTA)-level analysis of potential health and monetary benefits stemming from air quality management decisions. We evaluated the modeled 2016 PM2.5 values against observed values at EPA and NYCCAS monitors, finding good model performance (FAC2, 1; NMSE, 0.05). We, then, applied ZAPPA to assess PM2.5 reduction-related health benefits from five illustrative policy scenarios in NYC focused on (1) commercial cooking, (2) residential and commercial building fuel regulations, (3) fleet electrification, (4) congestion pricing in Manhattan, and (5) these four combined as a “citywide sustainable policy implementation” scenario. The citywide scenario estimates an average reduction in PM2.5 of 0.9 μg/m3. This change translates to avoiding 210–475 deaths, 340 asthma emergency department visits, and monetized health benefits worth $2B to $5B annually, with significant variation across NYC’s 192 ZCTAs. ZCTA-level assessments can help prioritize interventions in neighborhoods that would see the most health benefits from air pollution reduction. ZAPPA can provide quantitative insights on health and monetary benefits for future sustainability policy development in NYC.

Incorporating community perspectives in health impact assessment: A toolbox

Large infrastructure projects, such as mining and renewable energy projects, can affect the health of surrounding communities by changing the natural, physical and social environment. While there is limited understanding of potential health impacts of such projects on local populations in general, there is a particular need for community-driven and equity-oriented approaches to predict and manage such impacts.To assess health impacts as perceived by vulnerable communities affected by large infrastructure projects in sub-Saharan Africa, we present here a suite of qualitative data collection tools, which are complementary to the existing health impact assessment (HIA) tools. At the core of the toolbox are guides to conduct (i) transect walks to qualitatively map and systematically select study communities and (ii) participatory focus group discussions to explore perceived impacts on the wider determinant of health and related health implications from the perspective of the affected communities. This methodology was developed as part of a qualitative study evaluating perceived health impacts in local communities in industrial mining settings in East and West Africa.These flexible and intuitive tools produced reliable and comparable findings across different countries and contexts, suggesting that the tools can be applied in a broad range of large infrastructure project settings. The methodology, with its particular potential for translating qualitative research rapidly into visual outputs, is a promising addition to the existing, mainly quantitative HIA toolbox. Strengthening HIA driven by local communities can ultimately contribute to achieving the health-related targets of the Sustainable Development Goals (SDGs).

Estimating Mortality Related to O3 and PM2.5 under Changing Climate and Emission in Continental Southeast Asia

Air pollution causes adverse effects not only on the environment but also on human health. This study evaluated the excess mortalities in continental Southeast Asia that are related to future O3 and PM2.5 ambient concentration changes attributed to future climate change and emission change. The Environmental Benefits Mapping and Analysis Program - Community Edition (BenMAP-CE) was applied as a health impact assessment tool. In BenMAP-CE simulations, baseline scenarios presenting for the present year (2014) were compared against the control scenarios presenting for the future year (2050). The air pollutant concentrations for the simulations were collected from modeled data. The future population data and baseline incidence rates were as same as the 2014 levels. In four calculating countries namely Laos, Cambodia, Thailand, and Vietnam, on average, impacted by climate change alone, the avoided mortalities of -1164 and -3358 under Representative Concentration Pathway (RCP) 4.5 scenario and the additional mortalities of +758 and +2562 under RCP8.5 scenario were calculated for O3 and PM2.5, respectively. Future emission change alone under Evaluating the Climate and Air Quality Impacts of Short-Lived Pollutants current legislation (ECLIPSE CLE) scenario induces +7113 and +11072 additional O3 and PM2.5 related mortalities, respectively. Combined change in climate and emission produces additional O3 and PM2.5 related mortalities of +6067 and +7830 under RCP4.5 and ECLIPSE CLE combined scenario and +8763 and +14580 under RCP8.5 and ECLIPSE CLE combined scenario, respectively. The results of this study provided meaningful information for understanding the public health attributed to air pollution in the region.

Reducing the Burden of Disease Through Tobacco Taxes in Mongolia: A Health Impact Analysis Using a Dynamic Public Health Model.

Background/ObjectivesSmoking is the leading risk factor for many chronic diseases. The quantitative analysis of potential health gains from reduced smoking is important for establishing priorities in Mongolia’s health policy. This study quantifies the effect of tobacco-tax increases on future smoking prevalence and the associated smoking-related burden of disease in Mongolia.MethodsThe dynamic model for health impact assessment (DYNAMO-HIA) tool was used. The most recent data were used as input for evaluating tobacco-taxation scenarios. Demographic data were taken from the Mongolian Statistical Information Services. Smoking data came from a representative population-based STEPS survey, and smoking-related disease data were obtained from the health-information database of Mongolia’s National Health Center. Simulation was used to evaluate various levels of one-time price increases on tobacco products (25% and 75%) in Mongolia. Conservative interpretation suggests that the population will eventually adjust to the higher tobacco price and return to baseline smoking behaviors.ResultsOver a three-year period, smoking prevalence would be reduced by 1.2% points, corresponding to almost 40 thousand smokers at the population level for a price increase of 75%, compared to the baseline scenario. Projected health benefits of this scenario suggest that more than 137 thousand quality adjusted of life years would be gained by avoiding smoking-related diseases within a population of three million over a 30-year period.DiscussionPrevention through effective tobacco-control policy could yield considerable gains in population health in Mongolia. Compared to current policy, tax increases must be higher to have a significant effect on population health.ImplicationsTobacco taxation is an effective policy for reducing the harm of tobacco smoking, while benefiting population health in countries where the tobacco epidemic is still in an early stage. Smoking prevalence and smoking behaviors in these countries differ from those in Western countries. Reducing the uptake of smoking among young people could be a particularly worthwhile benefit of tobacco-tax increases.

Health impact assessment of COVID-19 confinement-related changes in environmental and health behaviour exposures on cardiovascular and mental health

BACKGROUND AND AIM: COVID-19 confinement changed environmental and health behaviour exposures, which are risk factors for non-communicable diseases. We aimed to quantify changes in physical activity (PA) and nitrogen dioxide (NO2) levels in response to confinements in Barcelona/Spain, Vienna/Austria, and Stockholm/Sweden, and estimate the number of myocardial infarction (MI), stroke, and depression diagnoses that would be prevented or in addition if observed changes in PA and NO2 levels were sustained, e.g. over one year. METHODS: Using the Urban and Transport Planning Health Impact Assessment tool, we calculated differences in exposure to PA and NO2 between pre-pandemic levels (baseline) and the period of the first COVID-19 surge in Europe between March 15th and April 26th, 2020 (counterfactual exposure) separately, for all three cities. Exposure risk functions were used to estimate the relative risk of the outcome for such a difference in exposure, if the counterfactual scenario exposure levels were sustained. Then, we derived attributable fractions among adult population for the exposure difference. RESULTS:PA decreased in Barcelona by 95±25%, in Vienna by 76±23%, and in Stockholm by 42±11%. If reduced PA levels in Barcelona were sustained, increases in the annual incidence would be as follows: MI:10% (95%CI: 4–16%), stroke: 10% (0–19%), and depression: 8% (5–10%). Measured NO2 levels during the counterfactual period were in Barcelona:17.0±2.4ug/m3 (-50±14%), in Vienna:14.2±1.5ug/m3 (-22±10%), and in Stockholm: 11.2±1.1ug/m3 (-9±10%). If reduced NO2 levels in Barcelona were prolonged, the following decreases in annual incidence would be anticipated for MI:5% (95%CI: -25–5%), stroke: -6% (-22–3%), and depression: -13% (-101–35%). CONCLUSIONS:COVID-19 confinements in Barcelona, Vienna, and Stockholm resulted in decreases in PA and NO2 levels in all three cities. With respect to MI and stroke incidences in all three cities, a prolonged decrease in NO2 levels would not outweigh the detrimental health effects of concomitant physical activity declines as observed in the counterfactual period. KEYWORDS: health impact assessment, COVID-19 confinement, non-communicable disease, physical activity, air pollution

Benefits of near-zero freight: The air quality and health impacts of low-NOx compressed natural gas trucks

ABSTRACT The use of low-NOx compressed natural gas (CNG) medium-duty vehicles (MDVs) and heavy-duty vehicles (HDVs) has the potential to significantly reduce NOx emissions and yield improvements in regional air quality. However, the extent of air quality improvement depends on many factors including future levels of vehicle deployment, the evolution of emissions from other sources, and meteorology. An analysis of the impacts requires modeling the atmosphere to account for both primary and secondary air pollutants, and the use of health impact assessment tools to map air quality changes into quantifiable metrics of human health. Here, we quantify and compare the air quality and health impacts associated with the deployment of low-NOx CNG engines to power future MDV and HDV fleets in California relative to both a business-as-usual and a more advanced fleet composition. The results project that reductions in summer ground-level ozone could reach 13 ppb when compared to a baseline fleet of diesel and gasoline HDV and MDV and could reach 6 ppb when compared to a cleaner fleet that includes some zero-emission vehicles and fuels. Similarly, for all CNG cases considered reductions in PM2.5 are predicted to range from 1.2 ug/m3 to 2.7 ug/m3 for a summer episode and from 3.1 ug/m3 to approximately 7.8 ug/m3 for a winter episode. These improvements yield short-term health benefits equivalent to $47 to $56 million in summer and $38 to $43 million in winter during episodes conducive to poor air quality. Additionally, the use of zero emission vehicle options such as battery electric and hydrogen fuel cell trucks could achieve approximately 25% to 31% higher benefits for an equivalent fleet penetration level due to the additional emission reductions achieved. Implications: The paper provides a quantitative estimate of the air quality and human health benefits that can be achieved through the use of novel compressed natural gas engines (i.e., low-NOx CNG) in medium- and heavy-duty vehicles and provide a comparison with zero emission vehicles. Thus, our findings will provide support for policy development seeking to transform the trucking sector to meet clean air and climate goals given the current struggle policymakers have with selecting between alternative truck technologies due to variance in factors like cost and technical maturity.

Shared use of electric autonomous vehicles: Air quality and health impacts of future mobility in the United States

Vehicle electrification, automation, and shared mobility – also referred to as the transportation three revolutions (3Rs) – are the emerging trends in future mobility. This study performed a comprehensive integrated analysis to investigate the potential future development of passenger transportation in the United States. A technical-economic mobility model, a chemical transport model, and a health impact assessment tool were utilized. This study first adopted several assumptions for vehicle sales under the impact of the 3Rs, and made projections to 2050 for vehicle stocks, distance travel, energy use, and carbon dioxide (CO2) emissions. This study then quantified the impacts of changing emissions on concentrations of fine particulate matter and associated health benefits. Compared to a projected 2050 business-as-usual case, the wide use of electrification could lead to reductions of ~50% in petroleum consumption and ~75% in CO2 emissions, and obtain health benefits of 5500 prevented premature deaths, corresponding to $58 billion annually. The net energy impacts of automation are highly uncertain, and the improved efficiency from automation might be offset by an increase in travel. Sharing would bring additional benefits. The combination of the 3Rs could maximize the energy savings, carbon mitigations, and health benefits. The results of this study suggest that policies/incentives are needed to promote the transition from single-occupied conventional vehicles to shared electric vehicles.

The impact of urban and transport planning on health: Assessment of the attributable mortality burden in Madrid and Barcelona and its distribution by socioeconomic status

BackgroundThe population living in urban areas is growing rapidly. The level of exposure to adverse environmental factors is detrimental to human health and is directly related to urban and transport planning practices. ObjectiveTo estimate the premature mortality burden of non-compliance with international exposure guidelines for air pollution, noise, access to green space and heat for Barcelona and Madrid (Spain), and its distribution among the population by the socioeconomic status (SES). MethodsThe Urban and TranspOrt planning Health Impact Assessment (UTOPHIA) tool was applied and the attributable premature mortality due to non-compliance with recommended exposure levels was estimated. The distribution of the attributable mortality burden among the population by SES was investigated through Generalized Additive Models (GAMs) adjusting for spatial autocorrelation and a cluster analysis was performed to identify attributable mortality hot spots. ResultsAnnually, 7.1% and 3.4% of premature mortality in Barcelona and Madrid, respectively, could be attributed to non-compliance with the international exposure recommendations for air pollution, noise, heat and access to green space. In addition, analysis by SES showed that in Barcelona lower SES areas had an overall greater attributable mortality rate, while in Madrid, the distribution of the attributable mortality burden by SES varied by exposure. ConclusionThis study shows the impact of environmental exposures on mortality and highlights the importance of taking integrated actions when designing cities considering the health impacts, but also the specificities of each city such as the socio-demographic context. Moreover, the high precision scale of the analysis enables the identification of environmental hazards and mortality hot spots providing a powerful tool to support priority-setting and guide policymakers towards a healthy, sustainable and just city for all of their residents.

Health considerations in active travel policies: A policy analysis at the EU level and of four member countries

Sustainable urban transport and active travel policies have the potential to positively and negatively impact health. They are critical to building healthy cities since they impact health determinants such as physical activity, air quality, noise, road safety, green spaces, social interaction and access to healthcare services. Such impacts translate into measurable health outcomes inherent to life expectancy as well as mortality and morbidity outcomes related to respiratory and cardiovascular diseases, diabetes, accidents, mental health, and citizen's quality of life. Coherently with the Health in All Policies (HiAP) framework developed by the World Health Organization (WHO), the new version of the European Sustainable Urban Mobility Plan (SUMP) Guidelines features a topic guide linking transport and health. This paper assesses the inclusion of health provisions and methodologies in urban mobility policy and planning documents of four European cities using a multi-level perspective. It considers the adoption of Health Impact Assessment (HIA) tools to integrate health evidence, objectives and measures in the decision-making process. The establishment of a link between active mobility and environmental risk reduction is observed across the countries analyzed. HIAs have been carried out to evaluate the benefits of mobility measures on health only in some cases.

Health impact assessment to predict the impact of tobacco price increases on COPD burden in Italy, England and Sweden

Raising tobacco prices effectively reduces smoking, the main risk factor for chronic obstructive pulmonary disease (COPD). Using the Health Impact Assessment tool “DYNAMO-HIA”, this study quantified the reduction in COPD burden that would occur in Italy, England and Sweden over 40 years if tobacco prices were increased by 5%, 10% and 20% over current local prices, with larger increases considered in secondary analyses. A dynamic Markov-based multi-state simulation modelling approach estimated the effect of changes in smoking prevalence states and probabilities of transitioning between smoking states on future smoking prevalence, COPD burden and life expectancy in each country. Data inputs included demographics, smoking prevalences and behaviour and COPD burden from national data resources, large observational cohorts and datasets within DYNAMO-HIA. In the 20% price increase scenario, the cumulative number of COPD incident cases saved over 40 years was 479,059 and 479,302 in Italy and England (populous countries with higher smoking prevalences) and 83,694 in Sweden (smaller country with lower smoking prevalence). Gains in overall life expectancy ranged from 0.25 to 0.45 years for a 20 year-old. Increasing tobacco prices would reduce COPD burden and increase life expectancy through smoking behavior changes, with modest but important public health benefits observed in all three countries.

An Episodic Assessment of Vehicle Emission Regulations on Saving Lives in California

Historically, California has been a world leader in the development and application of environmental regulations. Policies to address air pollution have reduced criteria pollutant emissions, improved regional air quality, and benefited public health. To this end, California has imposed strict regulations on light-duty, medium-duty, and heavy-duty vehicles to reduce ambient concentrations of health-damaging pollutants such as ozone and fine particulate matter (PM2.5). Here, we compare the impact on air quality in California should California not have adopted on-road vehicle regulations (No Regulations Case) with the air quality associated with current regulations (Regulated Case). Simulations of atmospheric chemistry and transport are conducted to evaluate the impact of emissions on ambient levels of ozone and PM2.5, and a health impact assessment tool is used to quantify and monetize societal impairment. Compared with the "Regulated Case," the "No Regulations Case" results in a maximum peak 8 h ozone level of 162 ppb and 24 h PM2.5 of 42.7 μg/m3 in summer, and 107 μg/m3 and 24 h PM2.5 in winter. The associated increases in the daily incidence of human health outcomes are $66 million per day and $116 million per day during peak pollutant formation periods in summer and winter, respectively. Overall, the findings quantitatively establish the role and importance of on-road vehicle regulations in protecting societal well-being.

The challenge of assessing social cohesion in health impact assessment.

Health impact assessment (HIA) is a method by which a policy, programme or project falling outside traditional health fields, may be judged as to its potential effects on the health of a population to mitigate negative impacts and strengthen the positive ones. Proposals are analysed from the perspective of all the determinants of health. In France, HIAs are mainly applied to urban development projects where social cohesion (SCo) is a major issue. Although the HIA method is well structured as a step-by-step process, there are no guidelines for assessing SCo. This article opens with literature review to clarify the concept of SCo and to understand how the built environment influences SCo and how social environment influence health. Drawing on this work, this paper presents an analytical framework to assess SCo, integrating both the spatial and physical dimensions of urban design and the perceptions of the neighbourhood characteristics. Following a brief overview of the key findings from applying this framework to HIA of an urban development project, the paper discusses its related strengths and weaknesses. The framework could be a useful tool for HIA as it embraces knowledge from both urban planning and social sciences. It also allows for an overall analysis of all the indicators without relying on a checklist. Nevertheless, it should be tested further to improve its validity.

Rapid health impact assessment of a Danish policy document: One Denmark without Parallel Societies: No Ghettos in 2030

In 2010, the Danish government identified socially vulnerable areas in Denmark and defined the most deprived areas as “ghettos.” In 2018, the acting government passed a policy document called “One Denmark without Parallel Societies: No Ghettos in 2030,” which aims to eliminate ghetto areas by 2030. The aim of this study was to conduct a rapid health impact assessment (HIA) of the policy. One ghetto area (Stengardsvej, Esbjerg) was selected for the HIA, and an equity-focused HIA tool was applied. A public health knowledge-based assessment was conducted on the policy-based health paradigm determinants. To gain an in-depth understanding of potential health impacts of the policy, two focus group discussions were conducted: one with municipal employees working in the area (four persons), and one with residents living in the area (five persons). The policy contains four key intervention areas: (1) housing, (2) place of residence, (3) crime prevention, and (4) early start in life. Positive health impacts could be expected to some extent in relation to “early start in life” through enhanced focus on education of children. Negative health impacts could be expected on “housing” and the focus on place of residence in the area. Crime prevention involves issues where the question of restriction of human rights can be raised. The most relevant health outcome mentioned by both residents and municipal employees was mental health. Quantification was not performed due to lack of specific data for targeted areas. The overall health impacts of the policy “One Denmark without Parallel Societies: No Ghettos in 2030” were rather negative. Besides leading to poor mental health, substantial economic losses can be expected as well as issues related to human rights.