north staffs hia health inequalities presentation 10-07-09

8/14/2019 North Staffs HIA Health Inequalities Presentation 10-07-09

1/17

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


2/17

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


3/17

Or put another way!


4/17

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.


5/17

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


6/17

The role of health care and the wider

determinants of health


7/17

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


8/17

How it all fits together

Cartoon by Simon Kneebone,published by Fran Baum (2007),

IIJHP&E,XIV, 2, 90-95


9/17

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,


10/17


11/17

The Streetcar Project

Network & Street Improvements


12/17

The Streetcar Project

The Route


13/17

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


14/17

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


15/17

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


16/17

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.


17/17

and mainstreaming the use of HIA

as a tool for healthy urban planning and project development

Helping to improve health and wellbeing

north staffs hia health inequalities presentation 10-07-09

Documents