Public Health and Environment - HIA Connect

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Public Health and Environment

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South East Asian and Oceania Regional South East Asian and Oceania Regional Health Impact Assessment Conference, Health Impact Assessment Conference, Sydney, 7Sydney, 7--9 November 20079 November 2007

Health Impact Assessment: Health Impact Assessment: protecting and promoting protecting and promoting

healthhealth

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South East Asian and Oceania Regional South East Asian and Oceania Regional Health Impact Assessment Conference, Health Impact Assessment Conference, Sydney, 7Sydney, 7--9 November 20079 November 2007

Health Impact Assessment :Health Impact Assessment :ProtectingProtecting and and promotingpromoting healthhealth

Robert Robert BosBos, , WHOWHO

Public Health and Public Health and EnvironmentEnvironment

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Health Impact Assessment

The dawn of Health Impact Assessment in WHO

• The forecasting efforts by PEEM.

• A gradually broadening scope from the health and thedevelopment perspective alike.

• A growing appreciation of strategic impact assessment.

• An increasingly strong basis for cooperation betweenHIAand health promotion.

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PEEM Guidelines 2Guidelines for forecasting the vector-borne disease implications of water resources development

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• A gradually broadening scope from the health and thedevelopment perspective alike.

• A growing appreciation of strategic impact assessment.

• An increasingly strong basis for cooperation betweenHIAand health promotion.

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A combination of procedures, methods and tools by which a policy, programme or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population.

Gothenburg consensus 1999

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A COMBINATION OF PROCEDURES, METHODS AND TOOLS THAT SYSTEMATICALLY JUDGES THE POTENTIAL, AND SOMETIMES UNINTENDED, EFFECTS OF A POLICY, PLAN,PROGRAMME OR PROJECT ON THE HEALTH OF A POPULATION AND THE DISTRIBUTION OF THOSE EFFECTS WITHIN THE POPULATION. HIA IDENTIFIES APPROPRIATE ACTIONS TO MANAGE THOSE EFFECTS.

IAIA/WHO 2006

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The evolution of Health Promotion

• Alma Ata and PHC.

• The Ottawa Charter for Health Promotion.

• Healthy Cities.

• Healthy Public Policy.________________________________________

• Health in PRSPs.

• WHO Commissions (Macro-economics; Social Determinants)

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The Bangkok Charter

The Bangkok Charter for Health Promotionin a Globalized WorldIntroductionScope The Bangkok Charter identifies actions, commitments and pledges required toaddress the determinants of health in a globalized world through healthpromotion.Purpose The Bangkok Charter affirms that policies and partnerships to empowercommunities, and to improve health and health equality, should be at the centreof global and national development.The Bangkok Charter complements and builds upon the values, principles andaction strategies of health promotion established by the Ottawa Charter forHealth Promotion and the recommendations of the subsequent global healthpromotion conferences which have been confirmed by Member States throughthe World Health Assembly.Audience The Bangkok Charter reaches out to people, groups and organizations that arecritical to the achievement of health, including:• governments and politicians at all levels• civil society• the private sector ….

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The Bangkok Charter: Commitments to Health for All

1. Make the promotion ofhealth central to the globaldevelopment agenda.

2. Make the promotion ofhealth a core responsibilityfor all of government.

3. Make the promotion ofhealth a key focus ofcommunities and civil society.

4. Make the promotion ofhealth a requirement forgood corporate practice.

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The Bangkok Charter: Commitments to Health for All

1. Make the promotion ofhealth central to the globaldevelopment agenda.

2. Make the promotion of health a core responsibility for all of government.

To ensure this, all levels of government should make the health consequences of policies and legislation explicit, usingtools such as equity-focused health impact assessment.

3. Make the promotion ofhealth a key focus ofcommunities and civil society.

4. Make the promotion ofhealth a requirement forgood corporate practice.

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On integration

in·te·gra·tionPronunciation: \�in-tə-�grā-shən\Function: nounDate: 1620 1: the act or process or an instance of integrating: asa: incorporation as equals into society or an organization of individuals of different groups (as races)b: coordination of mental processes into a normal effective personality or with the individual's environment2 a: the operation of finding a function whose differential is knownb: the operation of solving a differential equation3. Psychology: The organization of the psychological or social traits and tendencies of a personality into a harmonious whole.4. Electronics The process of placing more than one integrated circuit on a single chip.

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On integration, Encyclopedia Brittanica

Integration of preventive and medical care services

Medical care had its origin in the humanitarian motive of caringfor the sick, while preventive health services sprang from the need to protect a healthy environment from epidemic diseases. They grew apart, but recently the trend has been to integrate them within a comprehensive health service. Such an integration was the fundamental principle of public health… etc etc

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Social Impact

AssessmentEnvironmental

ImpactAssessment

HealthImpact

Assessment

The relation between Health Impact Assessment, EIA and SIA

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HIA in development - the timeline

Identification Feasibility Construction Decommissioning

Design Appraisal Hand-over

Evaluation

Pre-feasibility Negotiations Operations

Screening

Scoping Time

HIA Appraisal HIA Implementation Public Health Action Plan

report

Allocation resources

Public Health Action Plan

HIA PHAP

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Essential Health Sector Functions related to HIA

• Assistance in the screening and scoping of project options

• Drawing up the HIA Terms of Reference

• Appraising the HIA report

• Preparing an intersectoral action plan for health

• Setting up a framework for intersectoral action (e.g. MoU)

• Preparing a solid evidence-based position for negotiations

• Monitoring compliance with the recommended measures

• Monitoring the health status of local communities

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Relevance of HIA to Health Promotion

• HIA helps identify health promotion opportunities

• HIA provides a mechanism for the engagement of other sectors

• The HIA framework supports the developmentof healthy public policy

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Relevance of HIA to Health Promotion

• HIA helps the health sector liberate funds for health promotion

• HIA can provide an unbiased assessment of benefits and risks of all health sector intervention, including health promotion

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0

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Bể lu lớn phế thải Thùngphuy

KHạp Xô Bẫy kiến

tỷ lệ % DCCNtỷ lệ tập trung bọ gậy

æ bä gËy nguån cña vect¬ SXH t¹i tØnh dù ¸n CÊp n-ícKey breeding sites in water supply project areas

Study in Ninh Xuan commune, Camthanh district, Khanhhoa province,

Centre- VN in 2000

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UNICEF JarsSmall tanksJarsWellsDrumsToilet water tanks Buckets Ant trapsDiscardFlower vasesAquariumAnimal drinking troughOthers

UNICEF Jars produce

92% AE larvae

Dengue mosquito breeding sites in Ninh Xuan commune September 2000

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0

200

400

600

800

1000

1200

1400

1996 1997 1998 1999 2000 2001

Tỷ

lệ mắc

/100

.000

dân

3 xã có bể xây củaUNICEF7 xã không có bể xâycủa UNICEFTỉnh Khánh Hoà

Số ca mắc SXH tại Huyện Ninh Hoà 1996-2001Number of dengue fever cases in Ninh Hoa, 1996-2001

Cung cÊpbÓ n-íc

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Study in Trung Thanh commune, Vinh long province, Southern - Vietnam

0

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1997 1998 1999 2000 2001 2002 2003 2004 2005

Built storage container

Small jar < 100L4%

UNICEF style

jar>1000L CLDRWSS

29%

Standard jar>100L

67%

Dengue case in Trung Thanh, Vung Liem, Vinh Long from 1997-2005

Key breedinh sites in Trung Thanh, Vung Liem, Vinh Long 04/2006

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Relevance of Health Promotion to HIA

• Health promotion’s settings approach helps contextualize HIA

• Health promotion helps create awareness of the need for HIA in development planning

• Health promotion gives concrete shape to participatory approaches in HIA

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New leadership at WHO

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The six items on WHO’s current agenda

Fundamental health needs1. Health for Development2. Health Security

Strategy3. Strengthening Health Systems4. Evidence for Policy, Strategies and Evaluation

Operations5. Managing Partnerships6. Improving WHO Performance

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The Millennium Development Goals

The core health MDGs

MDG4 Reduce Child Mortality

MDG 5 Improve Maternal Health

MDG 6 Combat HIV/AIDS, Malaria and other diseases

MDG 7 Ensure Environmental Sustainability

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WHO’s 1948 priorities re-visited

1948 MDGsSexually transmitted diseases MDG 6 HIV/AIDS

Malaria MDG 6 Malaria

Tuberculosis MDG 6 Tuberculosis

Maternal and child MDG 3 & 4 Maternal and child health health

Environmental sanitation MDG 7 Environmental sustainability

Nutrition MDG 1 Fight hunger

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Health Security

Strengthened International Health Regulationsin the wake of emerging diseases

•SARS

•Avian influenza

•Nipah virus

•Ebola

•New types of haemorrhagic fevers

and increasingly drug resistant pathogens

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Health Security

Climate change and human health

• First publication 1989

• Major publication for Kyoto negotiations

• Update in 2006

• World Health Day 2008

• Recent restructuring: Public Health and Environment now in cluster Health Security and Environment

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Essential Functions related to HIA

Assistance in the screening and scoping of project options

Drawing up the HIA Terms of Reference

Appraising the HIA report

Preparing an intersectoral action plan for health

Setting up a framework for intersectoral action (e.g. MoU)

Prepare a solid evidence-based position for negotiations

Monitoring compliance with the recommended measures

Monitoring the health status of local communities

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Country-targeted HIA capacity building Lao PDR

● Nam Theun 2 dam site● Reservoir: 450 km2

● Volume: 3910 Mio m3

● Resettlement: 5700 people

(11) Program managment delivery

(10) Health services infrastructure

(9) Cultural health believes

(8) Psychosocial

(7) Exposure hazardous material

(6) Accidents and injuries

(5) Food and nutrition

+++++(4) Soil- and water-borne

(3) Sexually-transmitted infections

(2) Vector-related

(1) Respiratory diseases

EDCBAEDCBAEDCBA

OperationReservoir fillingConstructionEnvironmental health areas

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Country-targeted HIA capacity building Lao PDRMOH

OtherDepartments

Department of Hygiene and Prevention

Departmentof Curative Services

Steering Committee for implementation of the National HIA Policy.

Vice-Minister (Chair)

Director, DCS

Director, DHP

Division of EnvironmentalHealth

HIA Unit

Dr Onechanh, Head

Dr Vilayvone

Dr Khamla

Essential functions in HIA:�Screening of proposed projects

�Scoping and formulating TOR�Carrying out appraisal (quality control)�Completing Public Health Management Plan�Negotiating institutional arrangements and resource allocation�Monitoring

MOH technical back-up team1. Div. of Disease Prevention2. Div. of Environmental Health3. Div. of Mother/Child Health4. Div. of Health Promotion5. Centre for Environmental Health

& Water Supply6. Centre for HIV/AIDS &

Sexually Transmitted Infections7. Centre for Malaria, Parasitology

& Entomology8. Centre for Laboratory Services &

Epidemiology9. Centre for TB

10. Centre for Mother/Child Health 11. Dept of Curative Services

Focal points other ministries

STEA, Department for Environment

Committee for Planning and Investment

•Agriculture and Forestry (MAF)

•Energy and Mining (MEM)•Industry and Trade (MIT)•Communication, Transport, Post and Construction (MCTPC)•Labour and Social Welfare

others

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WHO HQ, its Regional and Country Offices

WHO Headquarters Geneva

Six Regional OfficesAfrica (Brazzaville)Americas (Washington DC)Eastern Mediterranean (Cairo)Europe (Copenhagen)S.E.-Asia (Delhi)Western Pacific (Manila)

>130 Country Offices in Member States

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Preventing Disease through Healthy Environments

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DiarrhoeaLower respiratory infections

Other unintentional injuries

Malaria

Road traffic injuries

COPD

Perinatal conditionsIschaemic heart disease

Childhood cluster

Lead-caused MMR

Drownings

HIV/AIDS

0 1% 2% 3% 4% 5% 6%

% of global disease burden in DALYs

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MalnutritionCerebrovascular disease

Asthma

Tuberculosis

Suicide

Depression

Poisonings

Falls

Hearing loss

Violence

Lymphatic filariasis

Lung cancer

0 1% 2% 3% 4% 5% 6%

% of global disease burden in DALYs

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Landscapes, lifestyles, livelihoods

•

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The WHO Commission on Social Determinants of Health

Public Health and Environment - HIA Connect

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