Health impact assessment (HIA) can magnify the positive impacts of health promotion in practice, but practitioners face many challenges in implementing it, from the difficulties of intersectoral work to a lack of resources. These challenges require flexibility and sometimes involve adapting best practices in health promotion and the typical HIA process. This article presents an agile approach to conducting HIA when the window of opportunity is short, resources are scarce, and the expected value of appraisal is uncertain. Accordingly, this approach prioritizes the recommendations step over the appraisal step, while proposing an iterative and co-constructive process involving a limited number of stakeholders. The approach is exemplified through a case study of an HIA conducted in Québec on a guide promoting green, active and safe transportation networks. We argue that the adapted method can, in certain circumstances, lead to better results than a typical HIA. The article also suggests contextual criteria that allow HIA practitioners to assess whether this approach is suitable for their needs.

Health impact assessments should be mandatory for all relevant government policies.

Integration of the exposome concept into health risk assessments: a challenge for health safety agencies.

ABSTRACT Health impact assessment (HIA), as a way to embed Health in All Policies, has been endorsed in Irish public health strategies since 2001. However, practice has varied. Given the demonstrated effectiveness of HIA in improving health considerations in projects, programmes and policies, and the relationship between the built environment and public health, an HIA on the Cork City Development Plan (2022–2028) was undertaken, with a focus on the 15-minute policy objective in the Core Strategy. Using the HIA stagiest approach as outlined in the Institute of Public Health Ireland guidance, combined with additional practice-based guidance, the HIA examined the policy objective through the lens of six determinants of health, namely housing, neighbourhood design, access to public spaces, models of travel, walkability, and accessible workplaces across three population groups, including older people, young people, and people living on low-income. Likely and significant health impacts were found associated with the policy objective implementation. Eleven recommendations were created, based on the health impact analysis, to promote population health and healthy equity for city inhabitants. The article shares reflections and lessons learned when undertaking an HIA in an unchartered policy context, using new HIA guidance with team members that are new to HIA practice.

Abstract Surface ozone pollution poses serious health risks worldwide while individual tropical cyclone (TC) can affect surface ozone through air transport and changes in meteorology influencing ozone formation. However, general variations in surface ozone under the influence of all TCs, as well as the corresponding health risks remain unclear. Using a High-resolution Air Quality Reanalysis Dataset over China (CAQRA), this study examines spatial-temporal variations of ozone and associated health risks during TC events from 2013 to 2019. Results show three distinct regional responses. In eastern coastal China, ozone decreases and reaches its minimum at the moment nearest to the TC center (0 h), due to strong winds and moist inflow. In southeastern and northeastern China, ozone rises slightly and then declines to its minimum about 34 h after 0 h, likely resulting from the changes of temperature and relative humidity (RH) and a lagging effect of strong winds. In central and southwestern China, ozone increases due to the high temperature and low RH near the peripheral circulation of TCs. Health impact assessments indicate the highest ozone-related risks concentrate in the eastern and southern China. These findings highlight the importance of incorporating the air pollution impacts induced by TCs into public health risk assessments.

This study assesses air quality and health impact in Hanoi, Vietnam, using the Community Multiscale Air Quality (CMAQ) model and health impact assessment to evaluate the effectiveness of traffic emission reduction strategies under two scenarios. An updated emission inventory was used as the input data for the CMAQ model. The Weather Research and Forecasting (WRF-CMAQ) model (version 5.4), incorporating the CB6 chemical mechanism, was applied alongside a calibrated meteorological model to simulate pollutant dispersion. The model achieved strong performance in PM2.5 simulation, with a correlation coefficient (R) of 0.78, an index of agreement (IOA) of −0.5, a Normalized Mean Bias (NMB) of 7.11%, and a normalized mean error (NME) of 28.51%. Seasonal analysis revealed higher concentrations of CO, NO2, O3, and SO2 in January compared to July, driven by traffic and industrial emissions. Improved air quality in July was attributed to favorable meteorological conditions, such as increased rainfall and clean airflows from the sea. Spatial distribution highlighted elevated pollutant levels in urban areas, while PM2.5 was significantly influenced by long-range transport and atmospheric processes. However, fine dust concentrations remained high in suburban areas, driven by secondary emissions and nearby industrial zones. An emission reduction scenario based on the Hanoi city policy decree focusing on traffic sources demonstrated its potential to reduce NO2, SO2, and PM2.5 concentrations, though the impacts varied across time and space. Health impact due to population exposure to PM2.5 shows that the densely populated suburbs surrounding the urban core have the largest impact in terms of mortality and cardiovascular diseases hospitalization. As PM2.5 has the largest impact on these two health endpoints, only PM2.5 impact assessment is performed. Health impact due to air pollution is higher in January (dry season) with estimated 625 deaths and 124 cardiovascular diseases (cvd) hospitalization as compared with estimated 94 deaths and 18 cvd hospitalization in July (wet season). One of the research questions posed by the city authority is whether converting diesel buses to electric buses can yield environmental and health benefits. Our work shows that the scenario based on Hanoi city decree of replacing 50% of fossil fuel combustion buses with electric buses by 2035 does not yield perceptible change in mortality health effect. This is due to emission from buses being small as compared to those from the whole transport sector and other sectors. This study emphasizes the need for integrated, targeted emission control strategies to address spatial and temporal variability in pollution. The findings offer valuable insights for policymakers to develop effective measures in urban planning for improving air quality and protecting the health of people in Hanoi.

Pollution characteristics and cancer risk of PAHs in a petrochemical industrial city: Insights from passive air sampling and three-dimensional dispersion modeling.

Research on the human health risks of climate change is expanding, yet the influence of polar region shifts on these risks remains underexplored. This paper presents a framework to assess global and regional health risks stemming from polar physical changes. The polar regions are experiencing rapid environmental transformations, including melting ice, ocean warming, ocean acidification, permafrost thaw, intensifying wildfires, and alterations to jet streams, ocean currents. These changes can amplify global risks, affecting human health even in distant regions. The paper identifies potential cascading impacts on health and well-being via drivers such as extreme weather, heat stress, air, water quality, food supply, safety, vector ecology, and sea-level rise. A scoping review was conducted by an international team of public health and polar experts to support thematic categorization of regional and global health risks. The paper advocates integrating these amplified risks into health impact assessments through interdisciplinary, international collaboration to inform future policy responses.

This paper examines the frequently neglected public health consequences of constructing metro rail and highways on adjacent villages, considering Indian law. As India's cities grow quickly and its economy grows, infrastructure development is speeding up. This is bad for the ‎health of people living near construction sites. Air pollution, noise pollution, contaminated water, and the stress of having to move your ‎whole life are all possible risks. For instance, the Center for Science and Environment (2019) says that since PM2.5, there have been more ‎instances of asthma and bronchitis in the affected communities. Five levels at construction sites for the Delhi Metro were three to five times ‎higher than what the World Health Organization says is safe. ‎ ‎ But the current rules in India don't do enough to deal with the health problems that come with these kinds of big city projects, even though ‎they do have these effects.‎ The analysis includes a thorough look at Indian laws, pertinent case law, and environmental rules. It also compares the legal systems of ‎other countries, such as the US, the EU, Australia, and Canada. These countries use health impact assessments (HIAs), public involvement ‎methods, and strict monitoring systems to plan infrastructure. ‎ The results show that the Indian court system generally puts economic or environmental issues ahead of health concerns, rather than community health. Health impact assessments are not actually a part of the process of managing infrastructure. There have been no systemic ‎legal protections or enforceable health standards put in place for infrastructure projects, even though the courts play a big role in establishing ‎the right to health under Article 21. ‎ This study highlights the importance of health impact assessments (HIAs), public involvement, and post-approval monitoring in ensuring ‎proper accountability for health outcomes. This article highlights the imperative necessity for reform by juxtaposing India's policies and ‎regulations with those of other developed countries. It calls for health impact assessments to be a required part of environmental impact ‎assessments (EIAs), more community participation, and health audits after projects. Health departments, urban planners, and legal bodies ‎should work together, it says, to institutionalize development that is more holistic and preventative. ‎ Rather than relying on reactive legal frameworks, the report argues for proactive frameworks that address health concerns at every stage of ‎infrastructure development. Public health must be recognized as an essential ethical and legal issue if India's urban development is to be ‎inclusive, sustainable, and socially equal. Detailed legal and policy recommendations are offered in the paper to align the administration of ‎India's infrastructure with the country's constitutional guarantee of the right to health‎.

Assessing the short-term air quality health impact from land-use changes during heatwaves: A health impact assessment in Barcelona Metropolitan Area.

Recent updates to international hypertension guidelines have converged toward a therapeutic target of <130/80 mmHg, as reflected in the JSH2025, AHA/ACC2025, and ESC2024 recommendations. Strong evidence from major outcome trials such as SPRINT, STEP, BPROAD, and ESPRIT has consistently demonstrated the benefit of intensive blood pressure (BP) control, particularly systolic BP < 130 mmHg, across a wide spectrum of hypertensive populations, including the elderly and those with diabetes, CKD, or cardiovascular comorbidities. The JSH2025 guidelines further emphasize home BP management, setting a lower target of <125/75 mmHg, supported by prospective nationwide studies such as J-HOP and HONEST. However, despite these advances in evidence and recommendations, real-world BP control rates remain unsatisfactory, underscoring the critical need for effective implementation strategies. To address this gap, we propose the "achievement rate of BP control <130/80 mmHg" as a unified, core implementation metric for hypertension management. This target is consistent with both JSH2025 and AHA/ACC2025 guidelines, as well as with Japan's Asakatsu campaign. We further recommend a dual-layered evaluation framework: a macro-approach (spatial, population-level) using office BP or health-check BP to assess outcomes in the general hypertensive population, and a micro-approach (temporal, individual-level) using home BP to monitor the quality of daily management and treatment adherence. Adopting this integrated framework will enable the simultaneous assessment of both public health impact and individualized care quality, providing a practical and evidence-based index for bridging guidelines with daily clinical practice. Ultimately, widespread application of this unified implementation metric has the potential to accelerate progress toward improved global cardiovascular outcomes. Core metric 130/80 mmHgof implementation hypertension. BP, blood pressure.

Ultra compact multi-channel particle sampler for personal exposure of particle chemical composition at hourly resolution.

Health impact assessment of greenness promotion on mortality in 98 cities in China

Knowledge-informed deep learning to mitigate bias in joint air pollutant prediction.

The National Institutes of Health (NIH) supported the Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) program, which aims to ensure that all Americans have access to COVID-19 testing and promotes health equity, especially in underserved communities. Under RADx-UP, there are two pilot programs - Community Collaboration Grants (C2G) and Rapid Research Pilot Program (RP2) - that fund projects to conduct community-engaged outreach and research to address COVID-19 testing disparities. As such, we sought to assess projects' health equity impacts within their priority populations. Our evaluation team used cognitive interviews with C2G and RP2 project representatives to revise health equity metrics within an existing Health Impact Assessment (HIA) tool to measure health equity impacts within these community-engaged research projects. During interviews, participants indicated that we needed to improve the clarity and readability of key terms and phrases related to health equity, and they provided suggestions for how to tailor metrics to community partners. In this paper, we highlight our process of adapting the original metrics and share lessons learned that other evaluators may apply to their work. Our project highlights the importance of cognitive interviewing as a critical methodology to tailor an existing pilot-tested HIA to a community-based audience; however, it also sheds light on the difficulties of measuring health equity within community-engaged research initiatives and future recommendations.

Evidence for the effectiveness of health impact assessment in spatial planning on health outcomes: A systematic review and stakeholder involvement from a UK perspective.

BackgroundHypertension is linked to elevated cardiovascular morbidity and mortality. Research findings regarding cardiovascular benefits of polyunsaturated fatty acids (PUFAs) are inconsistent, possibly due to unbalanced N6FA/N3FA (omega-6 to omega-3 polyunsaturated fatty) ratios and genetic predispositions in PUFAs utilization and cardiovascular disease (CVD) risk. This study investigates the association between plasma PUFAs and CVD risk among hypertensive adults, stratified by the polygenic risk score (PRS) for PUFAs and CVD.MethodsThe study analyzed 135,969 hypertensive adults from the UK Biobank. Cox regression models were employed to assess the links between PUFAs and cardiovascular outcomes, as well as the moderating effect of PRS.ResultsDuring the follow-up, 22,084 (16.2%) of participants experienced CVD events, and 2,336 (1.7%) and 13,823 (10.2%) died from CVD and all causes, respectively. Higher blood levels of total polyunsaturated fatty acids (Total PUFA), N3FA, N6FA, docosahexaenoic acid (DHA), and linoleic acid (LA) were associated with lower CVD incidence and mortality, for instance, the hazard ratio for N3FA was 0.745 [95% confidence interval (0.698, 0.796)]. Furthermore, the N6FA/N3FA ratio showed a positive association with CVD incidence and mortality, with the point of minimum risk estimated at approximately 8.70 based on restricted cubic spline analysis. Protective associations of Total PUFA, N6FA, and LA with CVD incidence were stronger in individuals with lower CVD – PRS scores.ConclusionDespite the general cardiovascular benefits of PUFAs, a higher N6FA/N3FA ratio was associated with an elevated risk of CVD in hypertensive participants. The benefits of PUFAs are greater in those with lower genetic CVD risk. This emphasizes the need to consider N6FA/N3FA balance and genetic predisposition when assessing health impact of PUFAs on CVD.

Monitoring skin health through parameters like skin hydration (SH) and transepidermal water loss (TEWL) is vital for diagnosing skin conditions and identifying disease factors. Conventional devices and survey-based methods often fail to deliver accurate diagnoses due to circadian rhythms of skin health data, limited measurement frequency, and patient subjectivity. Previous research has shown that prolonged device usage also causes sweat accumulation, compromising reliable monitoring. Here, we present a breathable skin health analyzer (BSA), a wearable device designed for prolonged use, capable of accurate, long-term measurement of SH and TEWL. The BSA addresses considerable obstacles in skin health monitoring by employing a breathable chamber and a bistable actuator that ensures both ventilation and consistent sensor contact with the skin. Validated through a 28-day clinical trial, the BSA and data processing algorithms demonstrated their effectiveness in providing reliable data by analyzing the correlation between particulate matter exposure and the skin barrier health. These results not only highlight the potential to improve the diagnosis and treatment of diseases but also show the possibility of contributing to individual environmental health impact assessments and translational studies.

BackgroundThe Family Physician Program (FPP) represents a crucial reform in the primary healthcare system. Assessing its impact is essential to inform evidence-based policy decisions and to enhance its effectiveness in improving population health. This study employed a Health Impact Assessment (HIA) framework to evaluate the influence of the FPP on key health outcomes in Iran and to generate actionable recommendations for optimizing its implementation.MethodA retrospective HIA using the Merseyside guidelines was conducted with a concurrent mixed-methods design across three phases. Phase I involved a quantitative analysis employing Interrupted Time Series Analysis (ITSA) over a 14-year period (2008–2021) to assess changes in health indicators following FPP implementation. Phase II used qualitative content analysis with interviews of 12 healthcare recipients and 7 providers from Bonab, Iran’s urban health centers, exploring program strengths, limitations, and health impacts. Phase III entailed a comparative integration of quantitative and qualitative findings to derive comprehensive policy and practice recommendations.ResultsAccording the quantitatve analysis, the Total Fertility Rate (TFR) initially exhibited a significant increase post-implementation (p = 0.007), followed by a gradual decline (p = 0.016). Modern contraceptive use declined (MCU) post-intervention, though likely influenced by unrelated national policy changes. The Infant Mortality Rate (IMR) experienced a marked immediate decline (p = 0.009), though the downward trend moderated over time (p = 0.045). Other maternal and child health indicators did not demonstrate statistically significant changes attributable to the intervention. Qualitative content analysis led to the identification of five main categories “Changes in Health-Oriented Beliefs and Behaviors of Service Recipients”, “Quantitative and Qualitative Enhancement of Service Delivery”, “socio-cultural and economic challenges”, “interpersonal communication” and “inefficient management”. The integration phase combined the quantitative and qualitative findings for a comprehensive interpretation.ConclusionWhile the FPP improved some health indicators, its overall effectiveness was constrained by socio-economic inequities, cultural barriers, and managerial inefficiencies. Strengthening the program requires systemic reforms, capacity-building, and addressing social determinants of health. Beyond Iran, this study offers a valuable framework for other low- and middle-income countries facing similar challenges in implementing large-scale primary care reforms, providing insights for optimizing program design and ensuring long-term sustainability.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-24788-5.

Bangladesh is among the most densely populated and climate-vulnerable countries in the world, where water quality degradation and air pollution are having a profound impact on public health. This study presents an integrated environmental management framework, which proposes the implementation of water and air quality improvement initiatives in harmony with the socio-economic realities of the country. Lab-based water and air quality testing, health impact assessment and GIS-based mapping have been completed under the mixed-methods approach. The results showed that the maximum arsenic level in the groundwater was 0.08 mg/L, which is much above the WHO standard (0.01 mg/L). Microbiological contamination in water (20–50 CFU/100 ml) is a health hazard in both urban and rural areas. In terms of air pollution, the concentration of PM₂.₅ in Dhaka is 120–180 µg/m³, which is 5–7 times higher than the WHO standard, and PM₂.₅ reaches an average of 350 µg/m³ in rural kitchens. The health assessment showed a 30% reduction in child diarrhea in households using water purification systems and a 25% reduction in respiratory diseases in households using improved cookstoves. Most importantly, where concerted action to improve water and air quality has been taken together, improvements in public health have been seen significantly. In conclusion, isolated initiatives to improve water or air quality are not sufficient. Integrated environmental management through policy reforms, technical interventions and community-based participation is essential to achieve effective results, which can be a viable model not only for Bangladesh but also for other developing countries.