Academic journal article Bulletin of the World Health Organization

Untapped Potential of Health Impact assessment/Un Potentiel Inexploite De L'evaluation De L'impact sanitaire/El Potencial No Explotado De la Evaluacion del Impacto Sanitario

Academic journal article Bulletin of the World Health Organization

Untapped Potential of Health Impact assessment/Un Potentiel Inexploite De L'evaluation De L'impact sanitaire/El Potencial No Explotado De la Evaluacion del Impacto Sanitario

Article excerpt

Introduction

At the first International Conference on Health Promotion, held in Ottawa in 1986, it was stated that "systematic assessment of the health impact of a rapidly changing environment --particularly in areas of technology, work, energy production and urbanization--is essential and must be followed by action to ensure positive benefit to the health of the public". (1) A quarter century later, this assertion is still true but health impact assessment (HIA) is seldom implemented, particularly in a developing country context. Nonetheless, the public and the private sector appreciate the value of evidence and health indicators for informed decision-making and health promotion, regardless of a given country's human development index (HDI). (2) Appropriately, the World Health Organization (WHO) has encouraged HIA as an important method for maximizing health promotion at the local, national and international levels. (3) Lee et al., in the March 2007 issue of this journal, elaborated on the role of HIA in bridging the relationship between health and foreign policy by drawing the attention of decision-makers to relevant health issues and generating new evidence. (4) Raising the profile of "health" is an important step towards holding governments, multilateral bodies and transnational corporations accountable for the potential health impacts of their policies and practices. (5) More recently, WHO presented HIA as a key approach for linking health to "green economy" and "institutional framework" strategies designed to put health at the heart of the agenda of the 2012 United Nations Conference on Sustainable Development (Rio+20).

We have performed HIA in a host of settings, particularly for projects in low-HDI countries, and we have observed that a concerted effort is needed to fully link HIA to the sustainable development agenda of the 21st century. (6) Population growth and urbanization, growing pressure on natural resources and global climate change are rapidly moving to centre stage and HIA is often conspicuously absent. Here, we summarize current HIA practice and outline the potential of iliA to become a critical player with the major drivers of global change.

Health impact assessment

WHO defines HIA as "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". (7) HIA is used to assess the likely effect of a policy, programme or project in a specific situation by drawing on the available evidence. (2) HIA engages different stakeholders, such as project proponents and affected populations. (8) It raises awareness among decision-makers that their actions can undermine health. Thus, HIA emphasizes the need for them to consider effects on health in all subsequent deliberations. (9) Finally, HIA serves as a tool to highlight interdependencies between different types of impact assessment (environmental, social and human rights) and among key stakeholders, for the purpose of strengthening collaboration towards health promotion and development. (3)

Current practice

HIA has grown and diversified over the past two decades to the extent that a considerable spectrum of HIA practice now exists internationally. (10) Several countries have established HIA practice as stand-alone processes (e.g. the United Kingdom of Great Britain and Northern Ireland), while others have integrated the assessment of health impacts into existing environmental and social assessment frameworks (e.g. Brazil). (11,12) At the national level, legislative approaches that support (e.g. United States of America) or require (e.g. Thailand) HIA are in place. (13) Other countries currently rely on voluntary processes with various degrees of government support and resources. (14,15) International financial institutions (e.g. Equator Principles Financial Institutions [EPFIs], the World Bank Group and the Asian Development Bank) are critical actors. …

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