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“Healthy Design at ADB”How to Design Health into Development Projects

Dr. Beverly Lorraine Ho

Consultant, SDCC

Disclaimer: The views expressed in this paper/presentation are the views of the author and do not necessarily reflect the views or policies

of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the

accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. Terminologies used may not

necessarily be consistent with ADB official terms.

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Outline

• Why HIA matters

• What are current HIA practices

•

How can HIA practices be improved• Key Takeaways

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Outline

• Why HIA matters

• What are current HIA practices

•

How can HIA practices be improved• Key Takeaways

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Population Health &

Safety

Development projects change

determinants that impact health.

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Story 1: Health Impacts of Energy Development

positives: affordable, lighting, refrigeration, time saving

negatives: resettlement, ecosystem disruption, malaria

3

2

1

http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwidgOXez7XKAhUHFqYKHYzLCFcQjRwIBw&url=http://article.wn.com/view/2010/09/10/Farmers_trained_on_latest_techniques/&bvm=bv.112064104,d.dGo&psig=AFQjCNFgLfukMOzqjP87-yCuhXUv5RLNLQ&ust=1453284136251179

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STORY 2: Health Impacts of Agriculture Development

positives: food security, food to sell at market, farming resilience

negatives: Japanese encephalitis, malaria, plus the above

dam

irrigation

unsustainable

livelihoods

resettlement

land compensation

sale of land to

urban residents

depression

suicide

facilitated by easy

access to pesticides

http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwidgOXez7XKAhUHFqYKHYzLCFcQjRwIBw&url=http://article.wn.com/view/2010/09/10/Farmers_trained_on_latest_techniques/&bvm=bv.112064104,d.dGo&psig=AFQjCNFgLfukMOzqjP87-yCuhXUv5RLNLQ&ust=1453284136251179http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwidgOXez7XKAhUHFqYKHYzLCFcQjRwIBw&url=http://article.wn.com/view/2010/09/10/Farmers_trained_on_latest_techniques/&bvm=bv.112064104,d.dGo&psig=AFQjCNFgLfukMOzqjP87-yCuhXUv5RLNLQ&ust=1453284136251179http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwidgOXez7XKAhUHFqYKHYzLCFcQjRwIBw&url=http://article.wn.com/view/2010/09/10/Farmers_trained_on_latest_techniques/&bvm=bv.112064104,d.dGo&psig=AFQjCNFgLfukMOzqjP87-yCuhXUv5RLNLQ&ust=1453284136251179http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwidgOXez7XKAhUHFqYKHYzLCFcQjRwIBw&url=http://article.wn.com/view/2010/09/10/Farmers_trained_on_latest_techniques/&bvm=bv.112064104,d.dGo&psig=AFQjCNFgLfukMOzqjP87-yCuhXUv5RLNLQ&ust=1453284136251179http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwidgOXez7XKAhUHFqYKHYzLCFcQjRwIBw&url=http://article.wn.com/view/2010/09/10/Farmers_trained_on_latest_techniques/&bvm=bv.112064104,d.dGo&psig=AFQjCNFgLfukMOzqjP87-yCuhXUv5RLNLQ&ust=1453284136251179http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwidgOXez7XKAhUHFqYKHYzLCFcQjRwIBw&url=http://article.wn.com/view/2010/09/10/Farmers_trained_on_latest_techniques/&bvm=bv.112064104,d.dGo&psig=AFQjCNFgLfukMOzqjP87-yCuhXUv5RLNLQ&ust=1453284136251179http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwidgOXez7XKAhUHFqYKHYzLCFcQjRwIBw&url=http://article.wn.com/view/2010/09/10/Farmers_trained_on_latest_techniques/&bvm=bv.112064104,d.dGo&psig=AFQjCNFgLfukMOzqjP87-yCuhXUv5RLNLQ&ust=1453284136251179http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwidgOXez7XKAhUHFqYKHYzLCFcQjRwIBw&url=http://article.wn.com/view/2010/09/10/Farmers_trained_on_latest_techniques/&bvm=bv.112064104,d.dGo&psig=AFQjCNFgLfukMOzqjP87-yCuhXUv5RLNLQ&ust=1453284136251179http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwidgOXez7XKAhUHFqYKHYzLCFcQjRwIBw&url=http://article.wn.com/view/2010/09/10/Farmers_trained_on_latest_techniques/&bvm=bv.112064104,d.dGo&psig=AFQjCNFgLfukMOzqjP87-yCuhXUv5RLNLQ&ust=1453284136251179http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwidgOXez7XKAhUHFqYKHYzLCFcQjRwIBw&url=http://article.wn.com/view/2010/09/10/Farmers_trained_on_latest_techniques/&bvm=bv.112064104,d.dGo&psig=AFQjCNFgLfukMOzqjP87-yCuhXUv5RLNLQ&ust=1453284136251179http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwidgOXez7XKAhUHFqYKHYzLCFcQjRwIBw&url=http://article.wn.com/view/2010/09/10/Farmers_trained_on_latest_techniques/&bvm=bv.112064104,d.dGo&psig=AFQjCNFgLfukMOzqjP87-yCuhXUv5RLNLQ&ust=1453284136251179http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwidgOXez7XKAhUHFqYKHYzLCFcQjRwIBw&url=http://article.wn.com/view/2010/09/10/Farmers_trained_on_latest_techniques/&bvm=bv.112064104,d.dGo&psig=AFQjCNFgLfukMOzqjP87-yCuhXUv5RLNLQ&ust=1453284136251179http://www.google.com.ph/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwidgOXez7XKAhUHFqYKHYzLCFcQjRwIBw&url=http://article.wn.com/view/2010/09/10/Farmers_trained_on_latest_techniques/&bvm=bv.112064104,d.dGo&psig=AFQjCNFgLfukMOzqjP87-yCuhXUv5RLNLQ&ust=1453284136251179

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Gains Losses

Health Impact Assessment anticipates health

gains and losses and manages these.

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Effective HIA has four elements

• Definition of health is clear & complete

• Properly-timed

• Fit for purpose – not ‘HIA for HIA sake’ • Upstream at the policy level or downstream at project

level

• Part of EIA or stand-alone

• Consider short and long-term time horizon

• Accountable public health management plan• Health promotion measures, health mitigation

measures

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Health experts are required for HIA

• Assistance in the screening and scoping of project options

• Drawing up the HIA Terms of Reference

• Appraising the HIA report• Preparing an intersectoral Public Health Management Plan

• 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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Outline

• Why HIA matters

• What are current HIA practices

•

How can HIA practices be improved• Key Takeaways

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Some healthin EIA and

SPRSS

•Efforts are

fragmented

Definition ofHealth

•Health is viewed

as a sector(medicalservices)instead oftheme

•Emphasis onoccupational &environmentalhealth

Ownershipand Capacity

•Neither health,

environment,nor social sectorfeelsaccountable

HIA in ADB

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ADB EIA: occupational, injuries,

pollution-related

• risk to human health and safety (e.g. from

generation, storage, or disposal of

hazardous wastes, inappropriate

occupational health and safety measures,

violation of ambient water or air quality

standards

SCREENING QUESTIONS  YES  NO  REMARKS 

B. Potential Environmental Impacts

Will the project cause..

☐  ☐ 

…  ☐  ☐ 

…public health risks from discharge of wastes and poorair quality; noise and foul odor from plant emissions?

☐ ☐

 

…occupational health hazards due to fugitive dust,

materials handling, noise or other process operations?

☐  ☐ 

…disruption of transit patterns creation of noise and

congestion, and pedestrian hazards aggravated by heavy

trucks?

☐  ☐ 

…disease transmission from inadequate waste

disposal?

☐  ☐ 

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ADB PSA: communicable disease focus

B. Affordability

C. Communicable Diseases and Other Social Risks

1. Indicate the respective risks, if any, and rate the impact as high (H), medium(M), low (L), or not applicable (NA):

Communicable diseases Human trafficking

Others (please specify) ______________

2. Describe the related risks of the project on people in project area.

VI. MONITORING AND EVALUATION

Source: ADB SPRSS template, Page 2, section B

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Malaria

STIs 

Cardio-vascular

disease 

Road traffic

injuries Diabetes 

Stress and

anxiety, isolation 

Malaria  Lung Disease  Electrocution  Wasting  Stress andanxiety 

Flu

STIs 

Hypertension

Asthma 

Communal

violence related

injuries 

Obesity 

Dementia,

alcoholism,

suicide 

Dengue

Ascariasis Poisoning  Drowning  Goiter  Cretinism 

Leptospirosis

Trichinella

Japanese

encephalitis 

Pesticide

poisoning 

Skeleto-

muscular

conditions, heat

stroke 

Stunting and

wasting 

Domestic

violence 

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Some healthin EIA and

SPRSS

•Efforts are

fragmented

Definition ofHealth

•Health is viewed

as a sector(medicalservices)instead oftheme

•Emphasis onoccupational &environmentalhealth

Ownershipand Capacity

•Neither health,

environment,nor social sectorfeelsaccountable

HIA in ADB

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DMC Policies on HIA

• Cambodia

 – Law on Environmental Protection and Natural Resources 1996 + Sub-decrees

 – Draft law on Environmental Impact Assessment with Section on HIA

• Lao PDR

 – National Policy on HIA 2006, all projects

• Myanmar

 – Environmental Conservation Law 2012

 – EIA Procedure 2015

• Thailand

 – Enhancement and Conservation of National Quality Act 1992, specified 12

projects

• Vietnam

 – Law of Environmental Protection 2014• EIA with public health component

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Vietnam: Project cycle – Strategic

Environmental Assessment (SEA) and EIA

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Outline

• Why HIA matters

• What are current HIA practices

•

How can HIA practices be improved• Key Takeaways

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TA 8763 RECAP Output 4

RMTF

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TA 8763 RECAP Output 4

HIA Advisory Group

Salim Vohra MBChB MSc PhD | Martin Birley BSc MSc PhD

Robert Bos BSc MSc | Yanyong Inmuong BSc MSc PhD

Filipe Silva BSc MSc | Astrud Lea Beringer MA

Genandrialene Peralta BS, PhD

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Tools/Checklists

Capacity Strengthening

4 Demo HIA + PHMP

TA 8763 RECAP Output 4

ADB level

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Hierarchy of Tools

Stand aloneHIA

Expanddefinition inPSA & EIA

Sector-specifictools

Public Health

Management

Plan

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TA 8763 RECAP Output 4

DMC level

Screeningchecklist

HIA PolicyDecree or

Regulation

Scopingchecklist

AdvocacyTools

Trainingmanual

HIA bestpractice

guidelines

Health

Environment

Planning

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TA 8763 RECAP Output 4

Regional level

FOURTH MINISTERIAL REGIONAL FORUM

on ENVIRONMENT and HEALTH in

SOUTHEAST and EAST ASIAN COUNTRIES

Manila, PhilippinesOctober 8-9 2016

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Outline

• Why HIA matters

• What are current HIA practices

•

How can HIA practices be improved• Key Takeaways

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Key Takeaways 

ADB

• Entry point to discusshealth with DMCs

• Introduce health as a

theme (relevant for ADBproject classification)

• Count health/PHMP ininfra project for health

sector lending

• Need health staff tosupport HIA efforts in RDs

DMCs Regional Work

• Policy framework exists

• Strength implementationcapacity

• Promote co-ownership (healthand environment) but clearaccountability

•

DMCs will have to report onSDGs, health determinantsimportant part of it