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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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