Health Impact Assessment Research Articles

Rapid health impact assessment of COVID-19 on families with children with disabilities living in low-income communities in Lusaka, Zambia.

Worldwide, children with disabilities are a vulnerable population and at high risk for COVID-19 morbidity and mortality. There is little information on the impact that COVID-19 had on children with disabilities and their families, particularly in low-income settings. This assessment describes the extent to which the pandemic impacted seven indicators of well-being in three low-income communities in Lusaka, Zambia. Interviews were conducted with a random selection of families participating in an existing program (n = 39), community health workers (n = 6), healthcare workers (n = 7) and government officials (n = 2). Descriptive data was summarized and qualitative responses reviewed for themes. Most families reported a major loss of income resulting in food insecurity (79%), housing instability (67%), stress (36%), and increased risk of child separation and neglect (18%). Most families did not report receiving governmental financial assistance and reported loss of access to health services for their child such as physiotherapy (33%). Stakeholders interviewed reported that COVID-19 information was widely available although few specific interventions for children. Families were seen to have greater food insecurity, more poverty, more crowding, less healthcare services and children left alone or on the streets to beg. COVID-19 and related containment measures have impacted the lives of children with disabilities and their families to a great extent. There is an urgent need for disability-inclusive responses that deliberately address the needs of children with disabilities and their families, notably uninterrupted access to adequate food, inclusive education, rehabilitation therapy, and income-generating activities.

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.

Scientometric analysis of health impact assessment of outdoor air pollution by WHO-AirQ tool (2005-2019)

Introduction: This study provides a scientometric analysis of the health impact assessment within AirQ between 2005 and 2019, which are listed in the web science databases. Studies have been conducted in various indexed journals, researchers in World Health Organization (WHO) regional areas on product articles, international collaboration, and citation and keyword analysis. Materials and methods: Bibliographic records of research publications and articles were found and after screening process were input to study plan. The authors compared the growth of article that was published in this period time, conducted a citation and co-authorship analysis, and keywords co-occurrences relationship by publication using the scientometric visualization, VOSviewer. Results: The AirQ applying tool in research literature has seen most increase in 2017 production over the study period. Contributions by authors affiliated with WHO-Eastern Mediterranean Regional Office (EMRO) account for the most research literature. Most of studies focus on particles Particulate Matter with diameter <10 µm (PM ) and Particulate Matter with diameter <2.5µm (PM 2.5) and according to total mortality and in hospital admission, Respiratory Disease (RD) and Cardio Vascular Disease (CVD) are most commonly. Conclusion: All potential of AirQ has not been used in studies. Despite all function its scope is limited to several countries in the WHO regions. Implementation of “Driving Force, Pressure, State, Exposure, Effect, and Action” (DPSEEA) conceptual model need some evidence that AirQ can achieve and estimate Health Impact Assessment (HIA) but we didn’t find any articles that work on intervention by it on policy makers and management programs.

Health impact assessment institutionalisation in France: state of the art, challenges and perspectives

ABSTRACT HIA implementation has rapidly grown in France. The question arises as to whether such growth is paving the way towards institutionalisation. An analytical framework was built based on the literature, capturing key dimensions characterising HIA practice and institutionalisation. Collected data draw upon documented HIAs, evaluation reports, direct observations and workshops. HIA practice in France follows a stand-alone procedure and is based on a holistic model of health. Its largely concerns intermediate HIAs commissioned by municipalities with the support of regional health authorities. Mainly applied to urban planning, HIAs are usually conducted by private firms, and local health observatories. Levers of institutionalisation include: an enduring tradition of intersectoral collaborations for health; a growing culture of health promotion; supportive environmental regulatory requirements; and policy frameworks and mandates addressing health inequalities at a regional and municipal level. For HIA to be more institutionalised, there is a need to clarify its purpose, continue building capacity, promote impact evaluations for evidence on HIA’ potential to advance HiAP and obtain greater commitment from national authorities.

Premature Mortality of 2050 High Bike Use Scenarios in 17 Countries.

Background:Biking plays a significant role in urban mobility and has been suggested as a tool to promote public health. A recent study has proposed 2050 global biking scenarios based on large shifts from motorized vehicles to bikes. No previous studies have estimated the health impacts of global cycling scenarios, either future car-bike shift substitutions.Objectives:We aimed to quantify changes in premature mortality of 2050 global biking scenarios in urban populations from 17 countries.Methods:Through a quantitative Health Impact Assessment, the mortality risks and benefits of replacing car trips by bike (mechanica bike and electric bike) in urban populations from 17 countries were estimated. Multiple bike scenarios were created based on current transport trends or large shifts from car trips to bike trips. We quantified the estimated change in the number of premature deaths (reduced or increased) concerning road traffic fatalities, air pollution, and physical activity. This study focuses on urban populations between 20 and 64 y old.Results:We found that, among the urban populations (20–64 y old) of 17 countries, 205,424 annual premature deaths could be prevented if high bike-use scenarios are achieved by 2050 (assuming that 100% of bike trips replace car trips). If only 8% of bike trips replace car trips in a more conservative scenario, 18,589 annual premature deaths could be prevented by 2050 in the same population. In all the countries and scenarios, the mortality benefits related to bike use (rather than car use) outweighed the mortality risks.Discussion:We found that global biking policies may provide important mortality benefits in 2050. Current and future bike- vs. car-trip policies should be considered key public health interventions for a healthy urban design. https://doi.org/10.1289/EHP9073

Noise Pollution in Onitsha Metropolis: Challenges and Solution

This study evaluated noise pollution in Onitsha metropolis, Anambra State, Nigeria in 2019. Noise levels were measured at forty sampling stations in the morning, afternoon and night within the study area for dry and wet seasons using modern noise level instruments. A control point was established at ldeani/Nnobi Junction with coordinates N 06o 05’.282’’ E 006o 55’.891’’ which was used as a reference point and for comparison with the sound levels recorded in designated locations. The results showed that the maximum noise level in the study area exceeded the Federal Ministry of Environment (FMEnv) limit by 7.8% in the dry season and by 13.11% in the wet season. Noise LAeq exceeded the NESREA LAeq limit by 29.89% in the dry season and by 33.44% in the wet season. The study indicated that the mean noise levels in the dry and wet seasons were within FMEnv limit of 90dB .It also showed that high noise levels were recorded around major junctions and market places within Onitsha, which are harmful to public health. The study further showed that transportation activities and trading activities at the market places are the main sources of high noise levels in the study area. Health impact assessment should be conducted in Onitsha metropolis for residents. State government should enforce compliance laws and regulate the activities of industries in the areas.

Health and Economic Impact Assessment of Transport and Industry PM2.5 Control Policy in Guangdong Province

PM2.5 pollution-related diseases lead to additional medical expenses and the loss of working hours, thus affecting the macro-economy. To evaluate the health-related economic impacts of PM2.5, the Integrated Assessment Model of Climate, Economic, and Environment (ICEEH), combined with the Computable General Equilibrium (CGE) model, the Greenhouse Gas and Air Pollution Interactions and Synergies (GAINS) model, and a health impact assessment module was constructed. The impact of different air pollution control strategies was analyzed in Guangdong Province by establishing a Without Control (WOC) scenario, an Air Control (AIC) scenario, and a Blue Sky (BLK) scenario. The results show that in the WOC scenario for 2035, the death rate for Guangdong Province is 71,690 persons/year and the loss of working hours is 0.67 h/person/year. In the AIC and BLK scenarios compared with WOC for 2035, the loss of working hours is reduced by 29.8% and 34.3%, and premature deaths are reduced by 33.0% and 37.5%, respectively; GDP would increase by 0.05% and 0.11%, respectively, through strict pollution control policies. Furthermore, improved labor force quality induced by better air conditions would promote the added value in labor-intensive industries, such as agriculture (0.233%), other manufacturing (0.172%), textiles (0.181%), food (0.176%), railways transport (0.137%), and services (0.129%). The added value in the waste (−0.073%), nature gas (−0.076%), and crude oil sectors (−0.072%) would decrease because of the increased investment installment in PM2.5 treatment equipment.

The health benefits of greening strategies to cool urban environments – A heat health impact method

Green infrastructure has the potential to cool urban environments and reduce the health burden due to heatwaves. This study develops a new method to quantify the benefits of urban heat mitigation technologies on human heat balance and population mortality. The Heat Health Impact (HHI) method is based on the state-of-the-art, multi-parameter model, Universal Thermal Climate Index (UTCI).A proof-of-concept exercise applied the HHI method to Sydney, Australia (population = 5.7 million). All available weather stations (10) were selected for full spatial coverage of the Sydney region (12,367 km2), and average hourly UTCI was calculated from meteorological observations spanning the entire year 2017. In the baseline analysis, average daily UTCI values were calculated for each of the 10 observation sites, and then spatially interpolated across the entire Sydney region for Feb 9, 2017, a representative heatwave day for Sydney. Three different greening intervention scenarios were investigated, and daily average change in UTCI (ΔUTCI) was calculated under each by comparison with the baseline scenario; this ΔUTCI was named Urban Cooling Effect (UCE). We implemented a health impact assessment methodology to estimate the change in attributable mortality due to each greening scenario for the Sydney GMR population for the representative heatwave day. Urban greening infrastructure scenarios reduced daily average UTCI between −0.2 and −1.7 °C on the heatwave day, with the health impact assessment indicating heat attributable deaths reducing up to 11.7 per day across the Sydney GMR compared to the baseline scenario. Our results highlight the health benefits of greening infrastructure to cool urban environments.

Quantifying the Health Benefits of Urban Climate Mitigation Actions: Current State of the Epidemiological Evidence and Application in Health Impact Assessments

While ambitious carbon reduction policies are needed to avoid dangerous levels of climate change, the costs of these policies can be balanced by wide ranging health benefits for local communities. Cities, responsible for ~70% of the world's greenhouse gas (GHG) emissions and home to a growing majority of the world's population, offer enormous opportunities for both climate action and health improvement. We aim to review the current state of knowledge on key pathways leading from carbon mitigation to human health benefits, and to evaluate our current ability to quantify health benefits for cities around the world. For example, because GHGs and air pollutants are both released during fuel combustion, reducing fuel burning can reduce both GHGs and air pollutants, leading to direct health benefits. Air quality improvements may be particularly important for city-scale climate action planning because the benefits occur locally and relatively immediately, compared with the global and long-term (typically, decades to centuries) benefits for the climate system. In addition to improved air quality, actions that promote active transport in cities via improved cycling and pedestrian infrastructure can reap large cardiovascular health benefits via increased physical activity. Exposure to green space has been associated with beneficial health outcomes in a growing number of epidemiological studies and meta-analyses conducted around the world. Finally, noise is an underappreciated environmental risk factor in cities which can be addressed through actions to reduce motor vehicle traffic and other noise sources. All of these environmental health pathways are supported by well-conducted epidemiological studies in multiple locales, providing quantitative exposure–response data that can be used as inputs to health impact assessments (HIAs). However, most epidemiologic evidence derives from studies in high-income countries. It is unclear to what extent such evidence is directly transferable for policies in low- and middle-income countries (LMICs). This gap calls for a future focus on building the evidence based in LMIC cities. Finally, the literature suggests that policies are likely to be most effective when they are developed by multidisciplinary teams that include policy makers, researchers, and representatives from affected communities.

Health and Economic Impacts Assessment of O3 Exposure in Mexico.

Health effects related to exposure to air pollution such as ozone (O3) have been documented. The World Health Organization has recommended the use of the Sum of O3 Means Over 35 ppb (SOMO35) to perform Health Impact Assessments (HIA) for long-term exposure to O3. We estimated the avoidable mortality associated with long-term exposure to tropospheric O3 in 14 cities in Mexico using information for 2015. The economic valuation of avoidable deaths related to SOMO35 exposure was performed using the willingness to pay (WTP) and human capital (HC) approaches. We estimated that 627 deaths (95% uncertainty interval (UI): 227–1051) from respiratory diseases associated with the exposure to O3 would have been avoided in people over 30 years in the study area, which confirms the public health impacts of ambient air pollution. The avoidable deaths account for almost 1400 million USD under the WTP approach, whilst the HC method yielded a lost productivity estimate of 29.7 million USD due to premature deaths. Our findings represent the first evidence of the health impacts of O3 exposure in Mexico, using SOMO35 metrics.

Health impact assessment of transportation noise in two Estonian cities

Transportation noise is a growing public health concern worldwide, especially in urban areas, causing annoyance, sleep disturbance, cardiovascular diseases and other health effects. Recently, European Commission (EC) has developed a mutual methodology for assessing health impacts of transportation noise in European Union using strategic noise mapping. Applying this methodology, our aim was to quantify the health effects of road, rail and aircraft noise in two Estonian cities, Tallinn and Tartu. We also aimed to assess sensitivity of this methodology, while implementing lower threshold values and employing additional health outcomes.The proportion of highly annoyed residents due to road traffic noise was 11.6% in Tallinn, and 9.2% in Tartu; around 2.5% residents in both cities could have high sleeping disturbances. As exposure to railway and aircraft noise was relatively low in both cities, people with high annoyance and high sleep disturbance caused by railway and aircraft noise was below 1%. Ischemic heart disease (IHD) cases attributable to road traffic noise was estimated to be 122.6 in Tallinn and 21.5 in Tartu. Altogether transportation noise was estimated to cause 1807 disability adjusted life years (DALYs) in Tallinn and 370 DALYs in Tartu. The health costs were calculated as €126.5 and €25.9 million annually, respectively in the two cities.When we included higher number of health outcomes (stroke incidence, IHD deaths) and lowered exposure threshold by 5 dB, the annual burden of disease was doubled. As the latest epidemiological studies showed transportation noise having larger number of effects on lower noise levels, the results with the currently applied European Commission health impact assessment (HIA) methodology were rather conservative. Despite of uncertainties associated to applied methodology, transportation noise, especially road traffic noise, is an important environmental risk factor, that leads to considerable loss of healthy life years and causes large health costs in urban areas.

Applying Health in All Policies at the University of Wisconsin-Madison

The University of Wisconsin-Madison’s (UW-Madison) response to the COVID-19 pandemic demonstrates how prioritizing health in campus policies is necessary to achieve better health, educational, and workforce outcomes. COVID-19 cases increased on campus as students attended in-person classes at the beginning of the 2020-21 academic year, though dampened as the university ramped up protective measures. Harm may have been prevented had proactive and analytical approaches to policy making, which are foundational to a Health in All Policies (HiAP) approach, been implemented sooner. Specifically, comprehensive and rapid Health Impact Assessments could enhance university leadership’s ability to mitigate the negative effects of existing and future policies. Here, we recognize the COVID-19 pandemic as a justifiable catalyst for implementing a HiAP approach in UW-Madison policymaking. We recommend that the university establish a HiAP subcommittee within the Division of Diversity, Equity & Educational Achievement. This action standardizes the use of tools essential to HiAP across campus while limiting the demand on existing university committees and other administrative offices.

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.

Assessment of human exposure to environmental sources of lead arising from the lead battery manufacturing and recycling sector in Europe: demonstration of a tiered approach in a case study.

Standard approaches for the assessment of Man via the Environment exposure are designed to be conservative. However, propagating these exposures into health impact assessment might lead to questionable socio-economic costs. The objective of this study was to develop a novel tiered modelling approach to assess human exposure to lead (Pb) via the environment. The approach starts in Tier 1 from EUSES modelling approach, modified with metal specific transfer factors. The generic Tier 2 approach uses the higher tier model GPM for air quality, and dietary exposure modelling based on EFSA's Comprehensive Food Database, in combination with crop specific transfer factors. Tier 3 considers additional site-specific information such as proximity of inhabitants and agricultural activities in relation to industrial sites. This tiered modelling approach was applied to a case study of 50 lead battery manufacturing and recycling sites across Europe. Data sets from general population human biomonitoring studies were used to compare the predicted additional bioburden of Pb resulting from lead battery manufacturing and recycling. The higher tier assessments were able to demonstrate a >20-fold reduction in modelled Pb exposure compared to default assumptions made in Tier 1. Leading to better estimates for socio-economic costs in health impact assessment.

Changes in household wealth in communities living in proximity to a large-scale copper mine in Zambia

Large-scale mining can alter the living conditions of surrounding communities in positive and negative ways. A health impact assessment conducted in the context of a newly developed large-scale copper mine in rural Zambia gave us the opportunity to measure changes in health determinants over time. We conducted periodic household surveys at baseline in 2011, during the construction phase in 2015 and during the operational phase in 2019. Data collected included economic indicators that were based on the standardized list of household assets used in the Zambia Demographic and Health Survey, which we subsequently converted into a wealth score using principal component analysis. We compared mean wealth scores in six communities directly impacted by the mine with comparison communities, as well as the rest of the North-Western province of Zambia. A difference-in-differences linear regression model was used to compare changes over time. Mean wealth of the communities near the mine was significantly lower at baseline than that of the North-Western province (−0.54 points; p-value<0.001) in 2011, but surpassed the regional average in 2019 (+1.07 points; p-value <0.001). Mean wealth increased more rapidly in communities directly impacted by mine than in the comparison communities (+0.30 points, p-value <0.001). These results suggest a positive impact on living conditions in communities living near this copper mine. Our findings underscore the potential of the mining sector to contribute to economic development in Zambia.

2.H. Workshop: Role of Health impact assessment in the policy-making process for the control of COVID-19 pandemic

Abstract The COVID-19 pandemic represents one of the most challenging health emergencies faced by humanity in modern history, with global effects on the economy and social well-being of people. This outbreak has abruptly brought public health back to the top of the policy agenda, making even more evident the need for adopting the comprehensive social determinants of health (SDOH) framework in designing effective mitigation and prevention measures. The novelty of the COVID-19 virus and the associated uncertainties about its health consequences and spread led to a massive generation of information from different sources, in some cases conflicting and contradictory. Conducting a systematic analysis and synthesis of existence scientific-evidence, considering all SDOH potentially affected, is crucial for supporting proportionated policy-decisions that reverse the spread of the virus and support health systems across Europe and worldwide. Health Impact Assessment (HIA) aims precisely at supporting the decision-making process by providing information and scientific evidence on the positive and negative effects that any new proposal may have on health and health equity. Its prospective nature also allows the introduction of corrective measures as an ongoing learning process, managing the estimated impacts and optimizing the health results of each proposal. HIA was launched as a methodology/tool by the World Health Organization (WHO) in 1999 and adopted by the EU in 2006 for supporting the development of healthier policies, projects and programs, related to both health and non-health sectors. However, its implementation in Europe is uneven across countries. The COVID-19 outbreak provides a good scenario for analysing the extent to which decision-makers are basing their decisions on the best available scientific evidence, and on the benefits of using the HIA approach. The present workshop will analyse and debate several experiences of using HIA as a supporting tool in the formulation of some of the most conflictive measures adopted by European governments related to the COVID-19 pandemic, such as ‘Lockdowns', ‘Staying at Home' and social distancing policies and requirements to work from home. Some of the questions that we intend to address in this workshop are: To which extent have decisions for managing the COVID-19 pandemic been based on the best scientific evidence available? What are the advantages of adopting an HIA approach in public health policy decisions? Are science and public health experts providing quick, synthetic and useful information for decision-making in the special circumstances of the current pandemic? Key messages COVID-19 pandemic reinforce the need for policy-makers based their decisions on best available scientific evidence through systematic processes such as HIA. Mitigation measures for the control of COVID-19 should go beyond healthcare assistance, making a more extensive implementation of HIA and a comprehensive approach to health.

Health impact assessment of a voluntary protocol to decrease salt in bread: what can we learn?

Abstract Issue Hypertension (HT) is a major and modifiable risk factor for cardiovascular diseases (CVD), which can be caused by excessive salt intake. Portugal has one of the highest mortality rate due to CVD in Europe, mainly due to HT. Thus, reduction of salt intake from food products is one of major strategies advocated to modify blood pressure (BP) and its impact on HT. Description of the problem The Portuguese population has excessive daily salt intake mainly due to bread consumption. Thus, in 2017 a voluntary ‘Protocol' was signed between stakeholders with the goal to reduce salt content in bread by 2021. Herein, using a Health Impact Assessment (HIA) approach we aimed to estimate the potential effect in BP from the implementation of this ‘Protocol'. Thus, two national surveys were used to find average values of salt intake and BP on population, while estimates of BP reduction were calculated based upon meta-analysis data. Results It was expected that the implementation of the ‘Protocol' could reduce salt ingestion and have a higher BP effect, mostly in more vulnerable populations. In fact, results showed that individuals with low educational level, men, aged and residents in the South region of Portugal were the ones that could more benefit from the ‘Protocol' implementation. However, this study found that the effects were be very low for all groups analysed, suggesting that only slight health gains can occur. Lessons The ‘Protocol' as a voluntary agreement is not sufficient to attain the public health targets devised. Following the HIA framework, further complementary and intersectoral integrated measures, through the use of compulsory food and fiscal policies preferably extended to other highly consumed food products, were thus recommended. HIA could be used as a comprehensive tool to assess health impacts, supporting at each national context the design and implementation of effective strategies to promote salt intake reduction and effectively prevent hypertension. Key messages The systematic use of HIA to design the appropriate policy framework and to inform adequately political decision-making is crucial to promote health and prevent Non-Communicable Diseases. Voluntary agreements should be complemented by other integrated measures to improve the efficacy of policies aiming to reduce salt intake and prevent hypertension.

HIA on lockdown and social distancing to contain the COVID-19 pandemic in Austria – results and lessons learned

Abstract The COVID-19 pandemic and the measures taken created opportunities in various areas of life, but also created new challenges or increased existing ones, which can also have a (direct or indirect) impact on health and well-being of the population or certain population groups. This health impact assessment (HIA) was commissioned to provide an overview of these effects. The foundation of gathering information for the impact assessment was a national literature research and analysis combined with an online survey. In addition, a search of international literature was conducted by the European Observatory on Health Systems and Policies. The impact assessment and an initial collection of recommendations for action were carried out together with relevant stakeholders in the context of several thematically merged online assessment workshops. Positive and negative - direct as well as indirect - impacts on health in different areas of life could be identified, with the negative impacts predominating in proportion. In addition to identifying the impacts, the HIA also identified groups that were particularly affected by the pandemic. In the course of this HIA, it became clear that the direct in indirect health impacts in many areas of life are interrelated (e. g., job loss, family climate, social inclusion, and psychological well-being) and that a separate discussion often fell short. This HIA provides an overview of various impacts and allows first impressions on actions for future measures in regard to the pandemic in various areas of life, according to the HiAP approach.

Climate Change in Wales and its health impact: Who is vulnerable and how?

Abstract In April 2019, Wales declared a climate emergency. Public Health Wales commissioned a Health Impact Assessment (HIA) to be carried out to assess the potential impact of Climate Change (CCh) on the population of Wales and inform key strategic decision makers to understand/plan for the potential differential health and inequalities impacts that may occur from CCh. A comprehensive mixed-method HIA was conducted over a 6 month period in 2019/2020. A review of peer-reviewed evidence on the potential impact of CCh/climate change events on health and population groups and a review of grey literature on direct impacts such as the environment, mental wellbeing and health care settings was conducted. 2 stakeholder workshops, qualitative interviews, a community health profile utilising sources such as the National Survey for Wales were also carried out. All findings were analysed, synthesized and collated into a report. Vulnerability is a critical aspect of population health and the HIA findings identified a range of positive and negative impacts on specific population groups which highlights their vulnerability to climate change. This includes children and young people; older people; coastal and rural communities and those on low incomes. These are often not explicitly highlighted in other environmentally focused assessments. The HIA also indicated significant potential impacts across the determinants of health including excess heat/cold; flooding; economy; access to services; mental well-being; and community resilience. The findings have informed decision-makers to prepare for CCh plans/policies using an evidence-informed approach and particularly to address who may be disproportionately negatively affected. The work has demonstrated the importance of HIA to assess significant, complex policies by mobilising a range of evidence through a transparent process, explicitly considering the impact on vulnerable groups, resulting in transferrable learning for others.

Maximising Social Value and Health Impact – what is the role of PHIs?

IssuePublic health Institutes (PHIs) need to build on traditional approaches to capture and measure their value and impact. As we transfer into the COVID-19 recovery phase, it is important to maximise the value of the health impact but also the social, economic and environmental impact of PHIs. Exploration is required to understand how the social value and impact of PHIs is, or can be, captured and measured. Existing research has illustrated the potential link between Health Impact Assessment (HIA) which assesses health and well-being through the lens of the determinants of health, and economic methods such as Social Return on Investment (SROI). This research aims to understand the current role which PHIs have, in order to strengthen advocacy for investment in public health and prevention in order to protect and improve population health.Description of the problemA scoping survey was designed and distributed digitally to national and regional PHIs via international networks. Semi-structured interviews were also used to add a qualitative value to the research to allow for triangulation of results. The survey data was analysed descriptively and interview data analysed thematically and coded.ResultsThe results of the research present an understanding of the meaning of investment, social value and health impact within PHIs including how it is measured using SROI and HIA. It also highlights whether PHIs have considered how capturing social value and health impact can contribute to the recovery from COVID-19, and whether they believe that SROI and HIA have a role in achieving this.LessonsThis innovative work aims to develop a picture of how PHIs are capturing and measuring the wider social, economic and environmental value of their programmes and services. Survey results will be used to help develop a framework for capturing the wider impact and value of public health at an international level, with an aim to achieving sustainable investment in future public health.Key messages Making the case for investing in public health by illustrating its social, economic and environmental value is vital.Understanding how to capture and measure the wider value of public health is imperative to aid the recovery from COVID-19.