PRESENTATION: Development and Health Impact Assessment

7/29/2019 PRESENTATION: Development and Health Impact Assessment

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Development and Health

Impact Assessment

Hisashi Ogawa

Disclaimer: The views expressed in this paper/presentation are the views of theauthor and do not necessarily reflect the views or policies of the Asian DevelopmentBank (ADB), or its Board of Governors, or the governments they represent. ADB doesnot guarantee the accuracy of the data included in this paper and accepts noresponsibility for any consequence of their use. Terminology used may notnecessarily be consistent with ADB official terms.


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Outline

Brief Guides to Health Impact Assessment

Development of Health Impact Assessmentin the Asia-Pacific Region

Health Impact Assessment in TransportSector


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Brief Guides to Health Impact

Assessment

See more at www.who.int/hia/en


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Economic

Environmental Social

Health Impact

Sustainable Development and Health*

* WHO Definition: Health is a state of complete physical, mental and

social well-being, and not merely the absence of disease or infirmity.


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Concepts of HIA Determinantsof Health

1. Determinants related to the individual: genetic,biological, lifestyle/behavioral and/or circumstantial.

2. Social and environmental determinants: physical,

community conditions and/oreconomic/financial.

3. Institutional determinants: the capacity,capabilities and jurisdiction of public sectorinstitutions and the wider public policy frameworksupporting the services they provide.

From IAIA Special Publication Series No. 5 Health Impact Assessment:International Best Practice Principles, September 2006


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What is a health impactassessment (HIA)?

Health impact assessment (HIA) is a combinationof procedures, methods, and tools used toevaluate the potential health effects of a policy,

program or project. Using qualitative, quantitative and participatory

techniques, HIA aims to producerecommendations that will help decision-makers

and other stakeholders make choices aboutalternatives and improvements to preventdisease/injury and to actively promote health.

From www.who.int/hia/en


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General HIA Process

1. Screening2. Scoping

3. Full scale HIA

4. Public engagement and dialogue5. Appraisal of the HIA report

6. Establishment of a framework for intersectoralaction

7. Negotiation of resource allocations for healthsafeguard measures

8. Monitoring

From IAIA Special Publication Series No. 5


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Examples of HIA Methods

Collection and analysis of appropriate secondarydata from relevant authorities

Interviewing key informants and conducting

focus group discussions in stakeholder groups Direct field observations in the bio-physical,

social and institutional environments.

Mapping using Geographical InformationSystems.

Review of relevant scientific and gray literature.

From IAIA Special Publication Series No. 5


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In practice, HIAs are applied

Within EIA (Environmental ImpactAssessment) system in countries

To priority environmental hazards incountries

To policies and plans in differentdevelopment sectors


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Development of HealthImpact Assessment in the

Asia-Pacific Region


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1980 1990 2000

History of WHO Support, 1980-2000:From EIA to EHIA

Development of EIA systems indeveloping countries, 1980s-early 1990s

ADBs HIAguidelines, Nov.1992

WHO RegionalWorkshop onEHIA, Nov. 1993

Country workshops, 1994-1997:Cambodia (1995); China (1995); Fiji(1996); Lao PDR (1995); Malaysia(1994); Mongolia (1997); Papua NewGuinea (1995, 1997); Philippines(1994, 1995, 1996); Solomon Islands

(1995); Viet Nam (1994, 1996)

National guidelineson EHIA, 1995-2000:Malaysia, PapuaNew Guinea,Philippines

WHO/ComSec EHIAworkshop,1995


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2000 2010

History of WHO Support, 2000-2010:From EHIA to HIA

Conducting HIA of environmental hazards*,2000-2005: China, Fiji, Lao PDR, Malaysia,Mongolia, Philippines, Viet Nam

Global HIA ofEnvironmental andOccupationalRisks**, WHR 2002

WHO RegionalWorkshop on HIA of

EnvironmentalHazards, Aug. 2003

Development of national capacity andpolicy for HIA, 2003-Present: Cambodia;Lao PDR; Mongolia; Viet Nam

Regional ForumsThematic WorkingGroup on HIA, 2010

Regional Forum on

Environment and Healthin Southeast and East

Asian Countries, 2004-Present

Environmental

Burden of Diseaseestimates**, 2006

Asia-Pacific HIAConference, 2007-Present

WHO Bulletin,ADB Primer, 2003

National strategyfor EHIA, SolomonIslands, 2009


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HIA of Priority EnvironmentalHazards in Countries

China, 2001 Environment and Peoples Health(urban air pollution; water pollution; and pollutionfrom small industries)

Fiji, 2003 An Assessment of Health Impactsfrom Environmental Hazards (water supply; airpollution; and chemical and hazardous waste)

Mongolia, 2003 Assessment of Health Impactsfrom Environmental Hazards (air pollution, watercontamination)


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Exposure-effect relationships for air pollution: log (annual mortality rate of respiratorydiseases)=0.3033 log(SO2)+0.964 log (annual mortality rate of cardiovascular

diseases)=1.991 log(SO2)+2.7426 log (annual mortality rate of lungcancer)=0.5722 log(SO2)+0.3149

Excess deaths due to air pollution:127,000 from respiratory diseases205,000 from cardiovascular diseases

44,000 from lung cancer376,000 in total

Economic loss:US$10.3 billion-19.3 billion (1.1%-2.0% ofGDP)


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Composite Health Risk Index, by Province inChina, 2001(indoor air quality, outdoor air quality, drinking water

quality, malnutrition and health services indices)


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HIA of Specific EnvironmentalHazards

Malaysia, 2004 A Study of Health Impact and RiskAssessment of Air Pollution in Klang Valley

Mongolia, 2004 Health Risk Assessment of Indoor AirPollution in Ulaanbaatar

Philippines, 2004 Public Health Monitoring (A Studyunder the Metro Manila Air Quality Improvement SectorDevelopment Programme)

China, 2005 Climate Change, Climate Variability andHealth

Lao PDR, 2007 Investigation of Indoor Air Pollutionand Relationship to Housing Characteristics and HealthEffects


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GIS important in identifying exposure risk areas in MMLA

Public Health Monitoring Study on Metro Manila Air Quality


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Apportionment by station

Traffic: 0.749

0.095

Biomass:

0.109 0.096

Sulphate:

0.07 0.021

: . . : . .

: : . .

: . : .

: . . : . .

: . . : . .

: . .

Traffic: 0.523 0.159

Biomass:0.134 0.068

Sulphate:0.18 0.102

Oil: 0.089 0.062

i : . . i : . .

: i : . .

: . . i : . .

i : i : . .

i : . . : . .

i : . .

l

Traffic: 0.846

0.055

Biomass:

0.054 0.033

Sulphate:

0.06 0.024

: . . : . .

: . : . .

: . : .

: . . : . .

: . . : . .

: . .

Traffic: 0.823

0.056

Biomass:

0.049 0.045

Sulphate:

0.065 0.03

: . . : . .

: : . .

: . . : . .

: . . : . .

: . . : . .

: . .

Traffic: 0.6

0.132

Biomass:0.216 0.139

Sulphate:

0.102 0.021

: . . : . .

: : . .

: . . : . .

: . . : . .

: . . : . .

: . .

l

l

Traffic: 0.725

0.098

Sulphate:

0.116 0.056

Biomass:

0.056 0.036

: . . : . .

: : . .

: . . : . .

: . . : . .

: . . : . .

: . .

ATENEO GOOD SHEPHERD (ANTIPOLO) EDSA (NATL. PRINTING OFF.)

PGH BGY. MAPULANG LUPA (VALZ) BF ALMANZA, LAS PINAS

Traffic emissions are main sources of PM Contribution of industries are evident in Valenzuela PM in Antipolo station reflects a mix of sources

Motor vehicles are the major source of PM pollution in MMLA

Public Health Monitoring Study on Metro Manila Air Quality


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HIA of Environmental Hazards inDevelopment Sectors

Regional EST (Environmentally Sustainable Transport)Forum, 2004 onwards Providing inputs on public health concerns

Supporting the health sector participation in national and

regional EST forums Environmentally Sustainable and Healthy Urban Transport(ESHUT) since 2009

China, 2005 - Transport and Health (traffic-related airpollution; noise; road traffic injuries; and physical activity)

Viet Nam, 2005 Health and Environmental Impacts ofPesticide Application

Regional Workshop on Health and EnvironmentLinkages (HELI) in Agriculture, 2006

Th il ti f


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0.55

1.38

2.56

1.6

2.2

3.2

4.5

0.29

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

1995 2000 2010 2020

Theoilconsum

ption(100milliontons)

The oil consumption of

transportThe total consumption

The oil consumption proportion of traffic in China

The proportion of motor vehicle emission tothe whole air pollution was 79% in 2005, andis increasing.

Lead poisoning in children is also common inChina. However, after 6 months from thecompulsory use of unleaded gasoline in 2000,the proportion of the lead poisoning in childrenaged 1-6 years decreased by about 13%.

Vehicle exhaust has become one of the main air pollution sources inmany big cities


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Social

activ ities

51.6%

Construction3.5%

Industry

10.7%

Others

10.7% Transport

23.5%

The percentage of urban noise sources in China

Traffic policemen who areexposed to noise of 73.876.8dB(A) showed that theincidence of hearing

impairment was 23.8%, whichwas nearly three times higherthan general population.

0

50000

100000

150000

200000

250000

300000

350000

400000

450000

500000

550000

600000

197819811984198719901993199619992002

The number of deaths

The number of injuries

0

5

10

15

2025

30

35

40

197819811984198719901993199619992002

Thedirectecon

omiccost

(0.1

billionYuan)

The number of casualties in road traffic accident

In 2002, the number ofdeaths on roads inChina represented 9.3%of the total number ofdeaths in the world. Theestimated annual cost of

traffic injuries in China isequivalent to US$12.5billion, almost four timesthe amount of the totalpublic health servicesbudget for the country.


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Use and Benefits of HIA ofEnvironmental Hazards

HIA of environmental hazards providesinformation for prioritizing environmentalhealth problems and locations of theproblems in the country, the Region, thearea, or the development sector assessed.

It, therefore, supports the arguments forrecommending policy options.


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Institution and Policy Development

EHIA Division of EHS in the PhilippineDOH in 1993

HIA Unit in MOH, New Zealand

HIA Division in MoPH, Thailand

National Policy on HIA in Lao PDR, 2006

National Policy and Strategy on HIA inCambodia and Viet Nam

Proposed HIA Act in Republic of Korea


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Health Impact Assessment in

Transport Sector


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Motorization

Urbanization

Increased

private motorvehicles

Dependency on

motor vehicles

Physical

inactivity

Obesity

Air pollution(PM, NOx,O3)

GHGemissions

Noise

Traffic crash

Cardio-vasculardiseases

Respiratorydiseases

Hearingimpairment

Injury

Climatechange

Increased

population

Increasedcommutingdistance

Decreased use ofpublic transport

Smoking inpublictransport &places

Barriers intransport

Driver-Pressure State-Exposure Health Effect

Increasedtemperature

Socialinclusion andwell-being

Lifestylechange

Road systemsand design

Vehicle technologies: cleanerengine & fuel, and safety devices

Traffic demandmanagement

Built environment

Rainfall changeIncreased heat wave, water

shortage, rainfall, flooding

Heat-related; vector-, water-,

and food-borne diseases

Environmentalcontrol & monitoring


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Health Effects ofTransport

Motorized Transport causes Air pollution respiratory and cardiovascular

disease and deaths Traffic accidents - injuries and deaths

Noise and vibration hearing impairment andpsychological effects

Traffic congestion psychological stress Physical inactivity obesity, hypertension,

cardiovascular and other NCDs Non-Motorized Transport (walk, bicycle) causes

Physical activity reduction in obesity and otherNCDs

No air pollution, noise/vibration, traffic congestion

Vulnerable to road traffic injuries


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Bicycle, WalkNon-Motorized Transport

Physical inactivity is a risk factor forobesity, hypertension, cardiovascular andother non-communicable diseases

30 minutes of bicycling/walking a day can halve the riskof heart disease

Switching from car to bicycle to travel 15 km increaseslife by 7 months recent study in the Netherlands*

Gain in life days/months per person

Air pollution -21 days (-0.8 to -40 days)Traffic accidents -7 days (-5 to -9 days)

Physical activity +8 months (+14 to +3 months)

* From J. J. de Hartog, et al. 2010. Do the health benefits of cycling outweigh the risks? Environmental Health Perspectives, Vol.

118, No. 8, pp1109-1116.


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Environmentally Sustainable andHealthy Urban Transport (ESHUT) Overall objective To promote a win-win, co-

benefit strategy (reducing carbon footprint andpromoting and protecting health) to build healthyurban transport system

Specific objectives To empowerAsian cities to: Promote non-motorized transport

(e.g. walking and cycling) Provide efficient public transport system,

including improvement in connectivityand access

Reduce use of private motor vehicles Provide smoking- and barrier-free

transport environments


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Examples of ESHUT Activities

Bicycle use support

Pedestrianization

Bus rapid transport and massrapid transit

Increased connectivity atstations/stops

Transport demand management

Barrier-free and safe roads,

walkways and public transport Health-promoting and hygienic

public transport


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Example: Bicycle CityChangwon

Changwon City, Gyeongnam-do is one ofHealthy Cities in Republic of Korea andpromotes a pro-bike policy (infrastructure forbicycle use, education to citizens, public bicyclerental system, etc.) since 2006.

In 2011, WHO commissioned a study to assess

the health benefits of this policy as part ofESHUT (Environmentally Sustainable andHealthy Urban Transport)


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Changwon Pro-bike Policy

The number of bicycles has increased to12,138 or 0.79 per household

The bike rental terminals are situated at163 locations with 1,807 rental bicycles

The factory workers who use bicycles towork has increased from 4.8% to 7.3%

(66% increase)


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Pro-bike Policy HIA Study*

Increased physical activities

HEAT (Health Economic Assessment Tool forBicycle Use) to estimates reduced mortality &associated economic savings

Reduced traffic accidents Time-series analysis of mortality due to traffic

accidents with and without the effects of policy

Reduced air pollutionAirQ (WHO EURO) to estimate the relative risk

(RR) attributable to change in air pollution

* Assessment of the Health Benefits of ESHUT Activities in Changwon City,Republic of Korea. Technical Report submitted to WHO, August 2011


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Main Results PhysicalActivity*

*Observed: as of 2009 when the data were available.Projected: planned or desired level after 5 years.

Assumed statistical value of life: 466,000,000KRW


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Traffic Accident Mortality inChangwon

12.7

15.7

13.2

17.8

12.3

2005 2006 2007 2008 2009

Age Standardized Death Rate(per 100,000)


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Traffic Accident Deaths by Type


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Air Pollution

0

2

4

6

8

10

12

0

10

20

30

40

50

60

70

80

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

NO2: ppbCO: 100 ppbSO2: ppb

PM10: ug/m3

O3: ppb

Pm10 NO2 O3 CO SO2


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Attributable Deaths due toPM10


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Future Prospects

More developing countries in Asia and thePacific to develop systems and strengthencapacity for HIA in EIA

Further experiences in applying HIA to social andeconomic determinants

Country-level (or city-level) HIAs of priorityenvironmental hazards and of developmentsectors (transport, housing, etc.)

Further development of national HIA policies andinstitutions, if appropriate, through TWG activities

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