In a world in which the population is fast becoming increasingly urbanised, in which technological and economic development is happening apace, and in which the balance between environment and health is coming under increasing strain, there is a growing need for new approaches to environmental health decision-making which can help to protect and improve the health of people in all areas of the world. The HEADLAMP methodology is aimed at providing such an approach. It represents an attempt to develop and apply a new model of environmental health decision-making which can improve public health not just as a one-off initiative, but by establishing long-term partnership between those involved, and by providing a firm information base for debate, management and policy.
Several principles and assumptions underlie the HEADLAMP approach. First and foremost, those concerned must genuinely use information to guide and support their decisions-information must lead to action. Second, this information must be relevant, balanced and reliable; it must go beyond partiality and opinion and provide sound and defensible evidence for action. Third, the approach must be holistic-it needs to set decisions within the wider context of causes and effects, so that the actions taken can be co-ordinated and integrated effectively and problems can be dealt with collectively, rather than as a set of separate and very specific issues. Fourth, it must be proactive and preventative: it must help to detect problems before they become acute and it must help to take action which avoids, rather than merely ameliorates, adverse health effects and promotes positive health outcomes. Finally, it must be inclusive, in that it should actively and fairly involve all the stakeholders concerned in ways which help to build consensus about the actions that are needed.
Each of these principles and assumptions has many implications, and raises both conceptual and practical questions. In this final chapter, therefore,
*This chapter was prepared by D. Briggs, G. Zielhuis and C. Corvalán