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8/14/2019 North Staffs HIA Health Inequalities Presentation 10-07-09
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Health Impact Assessment
as a key approach to tackling
health inequalities
Dr Salim VohraCentre for Health Impact Assessment, Institute of Occupational Medicine
Presentation 30th September 2008
8/14/2019 North Staffs HIA Health Inequalities Presentation 10-07-09
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Environment & health in context:
a complex web of factors
Adapted from Rapid Health Impact Assessment: a guide to research by Amanda Harris, 2002
genetic
factors
sex agediet
leisure
activities
sexual
behavioursmoking
alcohol
medication
illegal
substances
familyrelationships
housingtenure
employment
status
working
condition
income
educationpersonal
transport
socialcontact
socialsupport
community
participation
peer
pressure
fear ofcrime &
anti-social
behaviour
fear of
discrimination
crime &
anti-socialbehaviour
discrimination
health & social
care services
childcarecommunity
facilitiesleisure
facilities
education
& trainingadvice
services
housing
voluntary &
charity groups
public
transport
shops and banking
services
job
creation
distribution of
incomes
availabilityand quality of
training
availability and
quality of
employment
business
activity
research & technological
development
land use &
planningnatural
resourcesgreen
spacewastemanagement
public &environmental
health services
naturalhazards
smell
noise
air
quality
water
quality
soil
quality
Determinants of
Health & Wellbeing
Lifestyle
Social influences
Environment
Economic
conditions
Availability & access
Biologicalfactors
Personalcircumstances
ethnicitydisability
housing
conditions
personality
8/14/2019 North Staffs HIA Health Inequalities Presentation 10-07-09
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Or put another way!
8/14/2019 North Staffs HIA Health Inequalities Presentation 10-07-09
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Or even another way!
Health is a state of completephysical, mental and social wellbeingand not merely the absence ofdisease or infirmity
Health is therefore a resource foreveryday life, not the objective ofliving; it is a positive concept
emphasizing social and personalresources, as well as physicalcapacities.
World Health Organization, 1947 and 1984.
8/14/2019 North Staffs HIA Health Inequalities Presentation 10-07-09
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Difference in smoking lung cancer deaths in
three social groups and the west of Scotland
0
100
200
300
400
500
0 10 20 30 40
Average number of cigarettes smoked daily
West of Scotland
UK doctorsAmerican Cancer
Society volunteers
US veterans
Average
annual
death rate
/100,000
Source: Dr Harry Burns
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The role of health care and the wider
determinants of health
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Health Impact Assessment
1. Health impact assessment is the systematic prediction of the
potential positive and negative health and wellbeing impacts of newpolicies, plans, programmes and projects (proposals), including howthese impacts are distributed across the population.
2. It also generally provides a set of recommendations and/ or a set ofmitigation and enhancement measures so that positive health impactsare maximised and negative health impacts minimised within a givenpopulation.
3. HIA is therefore about both protecting health, by reducingexposures to harmful agents as well as, improving health bycapitalising on opportunities to promote and enhance health andwellbeing.
4. HIA is focused on tackling health inequalities generated by theuneven distribution of health impacts within an affected population.
5. HIA informs decision-makers so that they can health proof theirdecisions
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How it all fits together
Cartoon by Simon Kneebone,published by Fran Baum (2007),
IIJHP&E,XIV, 2, 90-95
8/14/2019 North Staffs HIA Health Inequalities Presentation 10-07-09
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HIA in the UK, WHO Health Cities
& Healthy Urban Planning
UK leading HIA country, recognised as such internationally
HIA seen as good practice nationally and locally
Strong bottom up approach to use of HIA
WHO Commission on the Social Determinants of Health advocates
the use of Health (Equity) Impact Assessment
Marmot Commission in England looking at how this work can be putinto practice in England
WHO Healthy Cities latest work programme has HIA at its heart
WHO writing an international good practice guide to HIA
Health and planning links increasingly being recognised by RTPI,CABE, National Heart Foundation, Natural England, RSPB,
8/14/2019 North Staffs HIA Health Inequalities Presentation 10-07-09
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8/14/2019 North Staffs HIA Health Inequalities Presentation 10-07-09
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The Streetcar Project
Network & Street Improvements
8/14/2019 North Staffs HIA Health Inequalities Presentation 10-07-09
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The Streetcar Project
The Route
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Health Impacts of the Streetcar Project
ASSUMPTIONS
CONTEXTUAL FACTORS THAT INFLUENCE WALKING AND BUS USE
Public transport availability,
accessibility, affordability and
ease of use
Personal preference,
motivation and intention to
walk and use bus
Commute time and travel plans in
school, hospital and workplaces.
Road safety education in schools.
Social/public health
marketing on the benefits of
using bus services
Poverty, disability
not having access to a
car and weather
Key users groups
to consider:
Children
Women
Older people
EthnicminoritiesPeople with
disabilities
Bus Rapid
TransportScheme
Improvement in
mental health
and wellbeing
Improvement in
physical fitness and
functioning
Decrease in obesity
Decrease in diabetes
Decrease in
cardiovascular
disease
CONTEXTUAL FACTORS THAT INFLUENCE WALKING AND BUS USE
Access to high number of
local shops and amenitiesalong/near bus route
Neighbourhood
attractiveness (includinggreenspace)
Neighbourhood disorder and safety: physical
dereliction, crime and incivilities, perceivedsafety, policing levels
Neighbourhood walkability: residential
density, land use mix,street connectivity and way-finding
Levels of traffic and road safety
and pedestrian infrastructure e.g.crossings, traffic calming
Decrease in some
cancers
Decrease in
osteoporosis
Decrease in traffic
related injuries and
falls in older people
Decrease in
exacerbations of
respiratory conditions
Reduction in
car usage
and cars on
road
Increase in
exposure to
the outdoors
Improvement
in journey
comfort
Reduction in
journey times
Quality of
buses and
related
infrastructure
e.g. bus
shelters, real
time
information
Improved
access to key
services/ and
amenities alongthe route e.g.
route goes
through hospital
Increase in
walking to
and from bus
stops
Improved
accessibility
to amenities
Increase in
interactions
with other
people
Improved
image of
Stoke
Decrease in air pollution
Decrease in noise pollution
Decrease in vehicle collisions
Improve traffic flow
Decrease in fossil fuel use
Increase in short term physical activityIncrease in long term physical activity
Make cycling/walking more attractive
Reduce climate change effects
Increase in interaction
with greenspace and public openspace
Increase in social capital and
community cohesion
Improved access to:
Entertainment, eating & drinking venues
Arts and leisure facilities
Health & social care services
Education & employment opportunities
Family & friends
Increase in civic pride
Increase in cultural capital
Increase in income
Increase in educational achievement
Increase in house prices along route
Enhance neighbourhoods along route
Increase inbus
patronage
(Streetcar
Scheme &
overall)
No or weak
evidence
Reasonable
or strong
evidence
Enhance wider local economy
Increase, decrease or no change in
actual or perceived crime/ incivilities
Positive impact
Negative impact
Social support:
supportive family, peers
and community
Increase in exposure to air pollution
Uncertain impact
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Recommendations of the Streetcar HIA
HIA report part of the Streetcar Business Case for Funding
Linking Street Improvements along the route with widerenvironmental/greening improvements along the Streetcar route
Use of all electric or hybrid low emission buses
Design of buses to include disabled and pushchair access(including need to have some level of noise form the bus enginesfor blind pedestrians and bus users)
Building in of maintenance budget for street improvements, real-time passenger information and buses within Business Case
Good communication and consultation plan for theconstruction/implementation phase
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Recommendations of the Streetcar HIA
Enhanced training for Streetcar drivers to deal with people withdisabilities
Encourage green travel plans with key organisation along theroute
Link into existing physical activity programmes
Set aside a small social marketing budget within the mainmarketing budget to encourage healthy behaviour change forpeople from all backgrounds
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Part of 4 HIAs Pilot Project
Middleport Regeneration Masterplanning
City Waterside Masterplanning
Leek Town Centre Refurbishment
Aim:
Embedding HIA in North Staffordshire through the development
of 4 HIAs, learning from these HIAs and the development ofhealthy urban planning and HIA tools where appropriate.
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and mainstreaming the use of HIA
as a tool for healthy urban planning and project development
Helping to improve health and wellbeing