making regarding the significant environmental consequences of projects, developments and programmes. Environmental health issues As considered in appraisal processes (EIA, SEA etc) including for example, air and water quality, noise, odour, contamination Equality Impact Assessment A process for identifying the potential impact of a project or land use policy, service and function on a population to ensure it reflects the needs of the whole community and minimise the potential for discrimination. Health A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Health Impact Assessment A combination of procedures, methods, and tools by which a policy, program or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population. HIA identifies appropriate actions to manage those effects. Integrated appraisal The combination of any of the following appraisal processes: environmental impact assessment, social impact assessment, health impact assessment, equality impact appraisal. Plan Spatial plan relating to a whole region, city, town or neighbourhood. It can include topic plans (e.g. for transport, housing and air quality). Project Specific development proposals requiring determination through a land use (spatial) planning process. Social Impact Assessment A methodology to review the social effects of infrastructure projects and other development interventions. Spatial planning A process intended to promote sustainable development and is defined as ‘going beyond’ traditional land use planning to bring together and integrate policies for the development and use of land with other policies and programmes which influence the nature of places and how they function. Strategic Environmental Assessment Strategic environmental assessment is required by European and UK law and has been adopted as an appraisal process in many countries across the world. It is a way of systematically identifying and evaluating the impacts that a plan is likely to have on the environment. The aim is to provide information, in the form of an Environmental Report that can be used to enable decision makers to take account of the environment and minimise the risk of the plan causing significant environmental damage. UK government
Wismar, M., et al (2007) NL + ++ HIA Plan for restructuring an industrial area into a residential area Low, Lower Middle and Upper Middle Income Countries (World Bank Country Classification as at February 2010) Study identification Author, year of publication Country Internal validity score ++/+/- External validity ++/+/- Appraisal type Subject of Appraisal None - - - - - Note: No relevant studies were identified in low, lower middle and upper middle income countries. 3.4 Findings of Evidence The findings are summarised in evidence tables and related evidence statements. Because of the differing regulatory frameworks within the UK and other high income countries, the studies have been grouped by type of appraisal as shown below: UK SA/SEA HIA Other Non-UK High Income Countries SEA HIA Other ‘Other’ might include any or a combination of SIA, SA, IA and EqIA and is taken to mean an appraisal that specifically includes environmental, social, health, economic and equity appraisal methods. The summary evidence tables indicate the findings of the data extraction (full details are in Appendix H) with respect to the objectives in 2.1, namely whether: Health issues were considered Health issues were incorporated into the plan There is evidence of the health recommendations being implemented
Outcome summary table: SA/SEA of plans in the UK • Evidence of inclusion О No evidence of inclusion NR Not reported NA Not applicable UC Unclear Process outcomes Specific health issues considered Quality score External validity score Significant finding comments Author, Year Topic Health issues considered Health recommendations incorporated Evidence of implementation Post adoption evidence PA MW EHI UI O Fischer, T., Matuzzi, M., Nowacki, J. (2009) Peterborough City Council Sustainability Appraisal of its Development Plan Document Scoping Report and Core Strategy Preferred Options Report • О NR NR • NR • О • + ++ Problem of the overall context within which SEA is applied: discretionary planning appears to support – at least potentially – “the consideration of various aspects that may go beyond those traditionally considered. While legalistic planning traditions appear to lead to a limitation of the factors for assessment to those legally required, they often appear to be used subsequently more consistently.” The Core Strategy itself did not mention ‘health’. Health stakeholders did not participate in the SEA process. & the health comments came from non-health bodies.
Fischer, T., Matuzzi, M., Nowacki, J. (2009) Sustainability appraisal of the Scoping Report and the Key Issues and Strategy Options of the Wrexham Local Development Plan, December 2006; and the associated 2008 ‘rapid HIA’. • NR NR NR • NR • • • + ++ The plan explicitly mentions health numerous times, particularly in the context of health services provisions. Relevant health background documents are listed A Council Health Promotion Team and a Local Health Body were involved in preparation of the SA, whilst the HIA was prepared by the Welsh HIA Support Unit and Wrexham Borough Council. It is suggested that HIA was not used in a fully proactive manner in order to influence the choice of preferred options, but rather in an ex-post manner for mitigating effects of developments that were already decided upon. Fischer, T., Matuzzi, M., Nowacki, J. (2009) Peterborough Local Transport Plan SEA which considered 1 option for major transport schemes against ‘do nothing’. Used assessment • UC UC NR • NR • • • + ++ Prepared by planning/environmental consultants with main on biophysical aspects. Presentation of baseline information was done in descriptive manner, with no maps and impacts limited to short, medium & long term. No explicit mention that decision makers were influenced by health related aspects of this SEA, although it is a requirement of the Directive that the influence of the overall SEA should be detailed. The authors suggest therefore that it is “probable” that health considerations had an impact. Problem of the overall context within SEA is applied: “discretionary planning appears to support – at least potentially – the consideration of various aspects that may go beyond those
3.4.2 Outcome summary table: HIA of plans in the UK • Evidence of inclusion О No evidence of inclusion NR Not reported NA Not applicable UC Unclear Process outcomes Specific health issues considered Quality External validity score Significant finding comments Author, Year Topic Health issues considered Health recommendations incorporated Evidence of implementation Post adoption evidence PA MW EHI UI O Douglas, M., Conway, L., Gorman, D., Gavin, S., Hanlon, P. (2001) HIA of Edinburgh City Council’s Local Transport Strategy. • UC NR NR • NR • • • + + “HIA can make explicit the health consequences of decisions in different sectors, including impacts on health inequalities. HIA should be done as part of community planning & other partnership activities & should become part of routine decision making.” Timing is key: must be part of an iterative process & considered at all stages of plan making, in order to influence decision making. Douglas M, Thomson, H, Jepson, R, Hurley, F, Higgins M, Muirie J, Gorman D (2007) HIA of West Yorkshire local transport plan 2000 • NR NR NR • NR • • NR ++ ++ For all the case studies below: brief summaries of completed HIAs – not critically appraised or evaluated HIA recommended to Promote physical activity Work with transport professionals trans[ort plans in NHS Douglas, M, Douglas M, Thomson, H, HIA of City of Edinburgh Council • NR NR NR • • • • • ++ ++ HIA Supported high cost scenario (out of 3 scenarios based on different levels of funding) and made recommendations to
Jepson, R, Hurley, F, Higgins M, Muirie J, Gorman D (2007) Urban Transport Strategy 2000 address impact of transport on health inequalities Douglas, M, Douglas M, Thomson, H, Jepson, R, Hurley, F, Higgins M, Muirie J, Gorman D (2007) HIA of London Mayoral strategy on transport 2000 • NR NR NR • • • • • ++ ++ HIA made recommendations to promote cycling and walking and include health measures in monitoring Douglas, M, Douglas M, Thomson, H, Jepson, R, Hurley, F, Higgins M, Muirie J, Gorman D (2007) HIA of Thurrock Local Transport Plan 2001 • NR NR NR NR • NR NR • ++ ++ HIA rapid assessment Using Swedish county council policy appraisal checklist Including; democracy/opportunity to exert Influence/equality Financial security Employment/meaningful pursuits. Education Social network Access to healthcare and social services Belief in future/life goals and meaning Physical environment Lifestyle factors HIA Supported the plan Douglas, M, Douglas M, Thomson, H, Jepson, R, Hurley, F, Higgins M, Muirie J, Gorman D (2007) HIA of 2003 West Midlands Local Transport Plan • NR NR NR • • • • • ++ ++ HIA Recommended priority given to: walking and cycling accidents and safety targets and monitoring air pollution social inclusion France, C. (2004) HIA of adopted Cambridge- shire Structure • • NR NR • NR • • • + + “Working closely with those developing the Structure Plan meant that there was a real opportunity to input into the process
Plan as part of a general review of SP policies and input to revision of emerging Structure Plan. and provide changes as the document emerged. The health care sector and land-use planners can work together to incorporate health issues into a strategic land-use planning document to the overall benefit of the community.” Glasgow Centre for Population Health (2007) Pilot HIA of Glasgow City Council’s draft East End Local Strategy • • NR NR NR • • NR • + - The fact that planners participated in the process allowed for a fuller understanding of the thinking behind the HIA suggestions. The participatory process using rapid appraisal techniques and bringing together people from a variety of backgrounds proved to be an effective way of integrating health into this strategy. The process also provided a common language for communication between stakeholders and operated as an innovative form of consultation. Greig, S., Parry, N., Rimmington, B. (2004) HIA of a Planning Study of M1 Motorway Corridor in Rotherham and Sheffield to inform an investment strategy for • • • • NR • • NR • + + Partial effectiveness of HIA noted, particularly environmental and community empowerment gains. The value that experience with HIA can provide to IA is a clear focus, in terms of content, on reducing social inequalities, and, in terms of process, on facilitating the participation of local communities in decision making which affects their quality of life.” “It is apparent that the areas where progress has been made have been those within very local control, where continued lobbying and action by local groups and .
3.4.4 Outcome summary table: SEA of plans in non-UK high income countries • Evidence of inclusion О No evidence of inclusion NR Not reported NA Not applicable UC Unclear Process outcomes Specific health issues considered Quality score External validity score Significant finding comments Author, Year Health issues considered Health recommendations incorporated Evidence of implementation Post adoption evidence PA MW EHI UI O Fischer, T., Matuzzi, M., Nowacki, J. (2009) Germany Regional plan of Western Saxony 2008 SEA • UC UC UC • NR • О • + ++ Health stakeholders can participate in SEA Authors think that the SEA has influenced decision-making because health is integral and that decision-making must take account off the SEA. However, impact likely to have been modest on other research results by same authors). Fischer, T., Matuzzi, M., Nowacki, J. (2009) Germany draft local statutory land use plan of Leipzig 2005 SEA • UC UC UC • NR • О • + ++ Consultation still under way at time of writing Health stakeholders can participate in SEA but not sure if they did here. Authors think that the SEA has influenced decision-making because health is integral and that
decision-making must take account off the SEA. However, impact likely to have been modest (based on other research results by same authors). Fischer,T., Matuzzi, M., Nowacki, J. (2009) NL structure vision for Emmen SEA • UC UC UC UC NR • • NR + ++ Health stakeholders can participate in SEA SEA appears to have been effective in influencing the final preferred development strategy But no details provided in the Kørnøv, L (2009) Denmark synthesis of 100 environmental reports in SEA SEA • NA NA NA • NR • • • + ++ Study only covers the outcomes assessed in environmental reports, synthesising 100 cases in Denmark In Denmark, municipal practice of SEA demonstrates: Health is included in planning assessment practice Health is interpreted in a broader sense than national guidance Aspects often included include: noise, drinking water, air pollution, recreation/outdoor life and traffic safety Both negative and positive impacts on health are assessed Assessment of human health is qualitative No reference to equity
3.4.5 Outcome summary table: HIA of plans in non UK high income countries • Evidence of inclusion О No evidence of inclusion NR Not reported NA Not applicable UC Unclear Process outcomes Specific health issues considered Quality score External validity score Significant finding comments Author, Year Topic Health issues considered Health recommendations incorporated Evidence of implementation Post adoption evidence PA MW EHI UI O Corburn, J. and Bhatia, R. (2007) USA Rezoning plan for the Eastern Neighborhoods of San Francisco HIA outside but parallel to a community planning process and its formal environmental review Eastern Neighborhoods Community HIA (ENCHIA) • UC NA NA • • NR NR • + ++ NB: Evidence of implementation and Post adoption evidence: NA as ENCHIA ongoing at time of writing. ENCHIA has got potential to influence policy: Provides a forum for citizens to enter into and frame planning issues ENCHIA reflects broader political consensus than at project level - Trinity and Rincon Hill’s HIAs1) HIA outside EIA can transform planning by generating new evidence with impacted stakeholders
Area plans and rezoning proposal for 3 contiguous neighbourhoods HIA through community visioning of 27 community health objectives HIA created an evaluation methodology through participatory process: healthy development measurement tool (HDMT) Planning commission endorsed use of measurement tool (HDMT) on plans and local land-use planning. This tool has been subsequently applied for 5 land-use plans locally. Area incorporated multiple policies and implementing actions were recommended through Healthy development measurement tool evaluation In terms of equity: HIA highlighted the importance of health disparities among racial and socioeconomic groups Dannenberg, A., Bhatia, R., Cole, B., Heaton, S., Feldman, J., Rutt, D (2008) USA City of Decatur Community Transportation Plan 2007 Plan for transportation system Rapid HIA – input from community leaders and local health and planning experts – literature review • • UC UC • UC NR • • + + City is infrastructure improvements; created an active living division to work across departments but it is unclear if this is a direct result of health recommendations being implemented in final draft plan and at post adoption stage
Farhang, L, Bhatia, R., Comerford Scully, C., Corburn, J., Gaydos, M. and Malekafzali, S. Year: 2008 USA Rezoning plan for the Eastern Neighborhoods of San Francisco HIA outside but parallel to a community planning process and its formal environmental review Eastern Neighborhoods Community HIA (ENCHIA) • UC NA NA • • • • • + ++ Production of 27 policy briefs informed by ENCHIA development of a Healthy development measurement tool which includes the following indicators: Environmental stewardship Sustainable and safe transportation Public infrastructure/access to goods and services Adequate and healthy housing Healthy economy Social cohesion subsequently HDMT was piloted on a project (executive park sub-area plan) SF council has used ENCHIA and HDMT to apply to its land use plans prospectively ENCHIA has increased council’s understanding of health issues ENCHIA has fostered new relationships between diverse constituent groups Gow, A. And Dubois, L. 2007 Australia Two potential residential developments in Bungendore Prospective HIA • • NR NR • • • • • + + NR: plan not advanced enough to report on this Interim results show match between proposed and actual outputs: 9 broad recommendations covering the identified health promoting elements have been included in local environmental plan, development control and developer contribution plan. Mathias, K., Harris-Roxas, B. New Zealand • • UC UC • UC • • • + + Process evaluation: Good integration of
2009 Greater Christchurch Urban development HIA Impact evaluation: Final UDS incorporated many policy components recommended in HIA (although not all to b attributed solely to HIA) Incorporation of HIA recommendation informal though Influence on policy approach did not however ensure that HIA recommendations were translated into actions. Neville, L., Furber, S., Thackway, S., Gray, E. & Mayne, D. 2005 Australia Shellharbour Foreshore Management Plan, environment management plan with some land use issues HIA • • NA NA • • NR • • + + NR: SFM not yet implemented at time of reporting. HIA process and final HIA report have assisted in the short and long term planning and implementation phases of the SFM plan: Cycle/walkway Landscaping and community art initiative were identified in HIA as key to benefit and were recommended for initial implementation in the plan Potential for HIA to Impact on physical activity and social cohesion Tennant, K. & Newman, C. (2007) Australia Greater Granville regeneration strategy HIA • • UC NR • • NR NR • + + Health impacts of the regeneration strategy have been identified by the HIA Outcomes (unclear if these outcomes have been implemented) development of recommendations changes to new bus timetables to meet needs discussion with NSW department o housing to see if HIA can be used as a tool for broader policy applications
3.4.6 Outcome summary table: other forms of assessment of plans in non-UK high income countries • Evidence of inclusion О No evidence of inclusion NR Not reported NA Not applicable UC Unclear Process outcomes Specific health issues considered Quality score External validity score Significant finding comments Author, Year Topic Health issues considered Health recommendations incorporated Evidence of implementation Post adoption evidence PA MW EHI UI O A. 2008 USA national petroleum reserve – Alaska – oil development plan, Alaska 2007 Plan for oil and gas leasing in the 4.6 million acre Northeast national petroleum reserve, Alaska • • NR NR NR • • NR • + + Process: Integrated HIA/EIA BLM agreed to include mitigation measures where legally permissible with later acceptance or rejection in subsequent stages of EIA process. BLM also agreed to consider working with a health advisory A. 2008 USA • • NA NA NA NA • • NR + + Process: EIA
Search Protocol The effectiveness of appraisal processes used in spatial planning to address health issues This search protocol outlines the proposed work to complete reviews 1 and 2 of the Spatial planning for health work programme: Review 1: The effectiveness of appraisal processes currently in use to address health and wellbeing during project appraisal Review 2: The effectiveness of appraisal processes currently in use to address health and wellbeing during plan appraisal Review Team
22 exp river/ or exp water management/ or exp flooding/ or exp seashore/ or exp rain/ 94307 23 (home$ or residen$ or accommodat$ or estate$ or hous$ or apartment$ or flat$ or condominium$).tw. 333491 24 exp home/ or exp housing/ or exp accommodation/ or exp residential area/ 25 (incinerat$ or landfill$ or waste or recycl$ or compost$).tw. 26 exp landfill/ or exp recycling/ or exp incineration/ or exp waste management/ or exp composting/ 82108 27 ((air or water or noise or land or soil) adj (quality or pollut$ or contaminat$ or protect$ or prevent$)).tw. 30227 28 exp air quality/ or exp air pollution/ or exp water quality/ or exp water pollution/ or exp noise pollution/ or exp soil pollution/ 144654 29 (eco#town$ or eco#village$).tw. 0 30 (eco adj town$).tw. 2 31 (built adj (environment$ or form)).tw. 339 32 exp building/ 3166 33 ((green or brown) adj field$).tw. 20 34 (greenfield$ or brownfield$).tw. 575 35 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33 or 34 7085661
36 exp city planning/ 342 37 (plan$ or masterplan$ or master#plan$ or framework$ or strateg$).tw. 654328 38 (project$ or proposal$ or develop$ or submission$ or application$).tw. 1991208 39 36 or 37 or 38 2435944 40 35 and 39 1838672 41 exp environmental impact assessment/ 8301 42 environmental impact assessment$.mp. 8434 43 environmental appraisal$.mp. 7 44 health impact assessment$.mp. 214 45 strategic environmental assessment$.mp. 30 46 social impact assessment$.mp. 13 47 social impact appraisal$.mp. 0 48 integrated assessment$.mp. 299 49 integrated appraisal$.mp. 3 50 sustainability appraisal$.mp. 1 51 equity impact assessment$.mp. 0 52 equity assessment$.mp. 3 53 equalit$ impact assessment$.mp. 2 54 equalit$ assessment$.mp. 1 55 41 or 42 or 43 or 44 or 45 or 46 or 47 or 48 or 49 or 50 or 51 or 52 or 53 or 54 8882 56 (knowledge or skill$).tw. 244309 57 exp professional knowledge/ 2563 58 (participat$ or engagement or stakeholder$ or consult$).tw. 237071 59 exp mental health/ 34235 60 exp wellbeing/ 17360 61 (mental adj (health or wellbeing or well-being)).tw. 38150
Quality score: + External validity score: ++ Specify: - new data collected on social determinants of health and available in one place to inform planning - report on health and safety in neighbourhood for sections of population often ignored by epidemiologic studies - development of a Healthy development measurement tool - 27 Policy briefs analysing positive and negative impacts of legislation on neighbourhood residents’ well-being opportunities for public participation BUT not transform planning in other crucial ways. Data extraction form
Title of paper: Use of Health Impact Assessment in the U.S. 27 Case Studies 1999-2007 Study details Population and setting Plan details and method of appraisal Outcomes assessed* Results Notes Authors Dannenberg, A., Bhatia, R., Cole, B., Heaton, S., Feldman, J., Rutt, D Year: 2008 Citation: American Journal of Preventative Medicine 2008; 34 (3) Aim of To document the growing use in the US of health impact assessment methods to help planners and others consider the health consequences of their decisions Study design: Review of 27 HIA case studies (some not relevant to this NICE review) Quality score: + External validity score: + Country: USA Setting (eg urban/rural) Various Population: Various – see individual case study information Equity: racial and socio-economic , demographics See below for case studies See below for case studies “Only limited information is available the impact that these 27 HIAs have had on decision processes. In a few cases, changes in policies or projects were made directly as a result of the HIA. More commonly, the HIA raised awareness of health issues among decision-makers and others; subsequent changes that occurred may be due in part to that increased awareness. HIA practitioners who have ongoing working relationships with local community leaders may be able to influence decisions more than those who lack such relationships. To accomplish change, such links may be more important than rigorous quantitative data in the HIA report. “ Limitations identified by author(s): Limitations identified by review team: information on individual case studies only reported in a table with article focusing on analysis Co authors involved as primary investigators or consultant for some of the HIA studied. Evidence gaps &/or recommendations for future research: More research needed to document the impacts of HIAs on decision processes and health outcomes Source of funding: N/R
Population: San Francisco – 14,000 existing + 12,000 future neighbourhood residents Equity: issues Plan: Rincon Hill Area Plan 2004– Area plan for new downtown residential neighbourhood Method of appraisal: Rapid desktop HIA Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in proposal: Y (iii) Evidence of being implemented: unclear (iv) Post-development evaluation: N/R b) Specific outcomes: (i) Physical activity: Y (ii) Mental wellbeing: Y (iii) Air / noise quality etc: Y (iv) Unintentional injury: Y (v) Other health: Y Specify: affordable housing , access to services and infrastructure c) Knowledge outcome: Planners health knowledge or skills: N/R d) Other outcome: NR Specify: Increased plan’s affordable housing requirement and improved its location: created community impact fund for community services and infrastructure HIA led to displacement protections Additional affordable housing Additional funds for parks and community facilities In terms of equity: HIA highlighted the importance of health disparities among racial and socioeconomic groups Population: San Francisco – 134,000 existing and 44,000 future residents Equity: issues linked to residence, ethnicity and socio-econ. Plan: Eastern Neighbourhoods Community 2006 Area and rezoning proposal for 3 contiguous neighbourhoods Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in plan: unclear (iii) Evidence of being implemented: NA HIA created an evaluation methodology through participatory process: healthy development measurement tool (HDMT)
Method of appraisal: HIA through community visioning of 27 community health objectives (iv) Post-development evaluation: NA b) Specific outcomes: (i) Physical activity: unclear (ii) Mental wellbeing: unclear (iii) Air / quality etc: unclear (iv) Unintentional injury: unclear (v) Other health: Y Specify: development of HDMT c) Knowledge outcome: Planners health knowledge or skills: Y through measuring tool d) Other outcome: N/R Specify: NB: baseline assessment of 100 community health indicators, so we assume that all the above are covered Planning commission endorsed use of a measurement tool (HDMT) on plans and local land-use planning. This tool has been subsequently applied for 5 land-use plans locally. Area plans incorporated multiple policies and implementing actions were recommended through Healthy development measurement tool evaluation In terms of equity: HIA highlighted the importance of health disparities among racial and socioeconomic groups Population: San Francisco – 134,000 existing and 44,000 future residents Equity: issues linked to residence, ethnicity and socio-econ Same plan as above Plan: Eastern Neighbourhoods Community 2006 Area plans and rezoning proposal for 4 contiguous neighbourhoods Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in proposal: Y (iii) Evidence of being implemented: NA Draft EIR adopted mitigation measures for air quality and noise impact Recommendations for pedestrians safety under review
Method of appraisal: EIA Predictive model of vehicle-pedestrian collision (iv) Post-development evaluation: NA b) Specific outcomes: (i) Physical activity: NA (ii) Mental wellbeing: NA (iii) Air / noise quality etc: Y (iv) Unintentional injury: Y (v) health: NR Specify: c) Knowledge outcome: Planners health knowledge or skills: N/R d) Other outcome: Specify: Population: 20000 residents and people who work and visit Decatur Equity: age, income and disability issues Plan: City of Decatur community transportation plan 2007 Plan for city-wide transportation system Method of appraisal: Rapid HIA – input from community leaders and local health and planning experts – literature review Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in proposal: Y (iii) Evidence of implemented: unclear (iv) Post-development evaluation: unclear b) Specific outcomes: (i) Physical activity: Y (ii) Mental wellbeing: unclear (iii) Air / noise quality etc: NR (iv) Unintentional injury: Y (v) Other health: Y Specify: access to health promoting goods and services – social capital City is making infrastructure improvements; created an active living division to work across departments
c) Knowledge outcome: Planners health knowledge or skills: N/R d) Other outcome: Specify: Population: Inupiat population Equity: ethnicity, cultural Plan: national petroleum reserve – Alaska – oil development plan, Alaska 2007 Plan for oil and gas leasing in the 4.6 million acre Northeast national petroleum reserve, Alaska Method of appraisal: Integrated HIA/EIA Stakeholder input Literature review Qualitative analysis Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in proposal: Y (iii) Evidence of implemented: NR (iv) Post-development evaluation: NR b) Specific outcomes: (i) Physical activity: N/R (ii) Mental wellbeing: Y (iii) Air / noise quality etc: Y (iv) Unintentional injury: N/R (v) health: Y Specify: socio-cultural issues, subsistence resources, access to alcohol and drugs c) Knowledge outcome: Planners health knowledge or skills: N/R d) Other outcome: Specify: BLM agreed to include mitigation measures where legally permissible with later acceptance or rejection in subsequent stages of EIA process. BLM also agreed to consider working with a health advisory board.
Study details Population and setting Plan details and method of appraisal Outcomes assessed* Results Notes Authors Douglas, M., Conway, L., Gorman, D., Gavin, S., Hanlon, P. Year: 2001 Citation: Health Bulletin 59(5) September 2001 Aim of study: To pilot approaches to HIA and make recommendations for its use as part of the planning & policy making processes in Scotland. Study design: Two HIAs were done as case studies (1 relevant), both in partnership with professionals responsible for developing the strategies. Quality score: + External validity Country: Scotland Setting (eg Largely urban Population: (size, characteristics…) City of Edinburgh Council area: mix of affluence & deprivation Plan: City of Edinburgh draft Local Transport Strategy, designed to reduce traffic congestion. The strategy considers 3 possible transport scenarios & 3 different funding assumptions. Method of appraisal: HIA Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in plan: UC (iii) Evidence of implemented: NR (iv) Post-adoption evaluation: NR b) Specific issues: (i) Physical activity: Y (ii) Mental wellbeing: N (iii) Air / quality etc: Y (iv) Unintentional injury: Y (v) Other health: Y Specify: - access to amenities - impacts on community networks c) Knowledge outcome: Planners health knowledge or skills: Y d) Other outcome: NR Specify: The HIA found that the most detrimental effects of transport were concentrated in more disadvantaged communities. The scenario with greatest funding would produce the greatest health gain, & the scenarios with lower funding would have detrimental effects on health inequalities. Recommendations were made to the transport planners & “these informed the development of the transport strategy …[this was] consulted on…& is being developed further” “HIA can make explicit the health consequences of decisions in different sectors, including impacts on health inequalities. HIA should be done as part of community planning & partnership activities Limitations identified by author(s): None Limitations identified by review team: Author involved in preparing the HIA Evidence gaps &/or recommendations for future research: - Source of funding: The Scottish Executive funded the Scottish Needs Assessment Programme to carry out the 2 pilot HIAs & to develop guidance from the lessons learned.
details Population and setting Project details and method of appraisal Outcomes assessed* Results Notes Authors Farhang, L, Bhatia, R., Comerford Scully, C., Corburn, J., Gaydos, M. and Malekafzali, S. Year: 2008 Citation: Journal of Public Health Management Practice 2008 14(3), 255-265 Aim of study: Examines whether and how the social and physical determinants of health have been integrated into the planning process through HIA. Describes the ENCHIA process, key outcomes and lessons learned and provides an overview of the healthy development measurement tool Study design: case study but method not describe, Country: USA Setting San Francisco Population: some focus on declining health of Latino and African American population in some neighbourhoods where regenerations is planned and existing tenants evicted; low-income population in general Plan: rezoning plan for the Eastern Neighborhoods of San Francisco Method of appraisal: HIA outside but parallel to a community planning process and its formal environmental review Eastern Neighborhoods Community HIA (ENCHIA) Outcomes measured : a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in plan: unclear (iii) Evidence of implemented: NA (iv) Post-development evaluation: NA process at time of writing b) Specific outcomes: (i) Physical activity: Y (ii) Mental wellbeing: Y (iii) Air / noise quality etc: Y (iv) Unintentional injury: Y (v) Other health: Y Specify: HDMT includes the following indicators: - Environmental stewardship Sustainable and safe transportation Public infrastructure/access to goods and services Adequate and healthy housing Healthy economy Social cohesion Many sub-indicators under each heading. c) Knowledge outcome: Planners health knowledge or skills: Y Production of 27 policy briefs informed by ENCHIA development of a Healthy development measurement tool which includes the following indicators: Environmental stewardship Sustainable and safe transportation Public to goods and services Adequate and healthy housing Healthy economy Social cohesion subsequently HDMTwas piloted on a project (executive park subarea plan) SF council has used ENCHIA and HDMT to to its land use plans prospectively ENCHIA has increased council’s understanding of health issues Limitations identified by author(s): Limitations identified by review team: Evidence gaps &/or recommendations for future research: Source of funding: N/R
use of documentary evidence Quality score: + External validity score: ++ d) Other outcome: Y Specify: -development of a Healthy development measurement tool ENCHIA has fostered new relationships between diverse constituent groups Data extraction form Title of paper: The consideration of health in strategic environmental assessment (SEA)
Study details Population and setting Plan details and method of appraisal Outcomes assessed* Results Notes Authors Fischer, T., Matuzzi, M., Nowacki, J. Year: 2009 Citation: Environmental Impact Assessment Review Vol 30 (3) (2009)200–210 Doi:10.1016/ j.e.i.a.r.2009.10.005 Aim of Based on a review of eight SEAs a discussion of the extent to which health aspects are considered in EU Directive based SEAs Study design: SEA case studies identified from EU and then analysed for health considerations Quality score: + External validity ++ Country: European Union Setting (eg urban/rural) Various (see individual case studies where applicable) Population: (size, characteristics…) Various (see individual case studies where applicable) See case studies below See case studies below General Comments: Problem of the overall context within which SEA is applied: discretionary planning appears to support – at least potentially – “the consideration of various aspects that may go beyond those traditionally considered. While legalistic planning traditions appear to lead to a limitation of the factors for assessment to those legally required, they often appear to be used subsequently more consistently.” “What is clear from the analysis provided in this paper, is that health related factors are considered in EC Directive based SEA, but current practice suggests that some gaps remain towards achieving planning systems that can effectively deliver health inclusive SEA.” Limitations identified by author(s): None Limitations identified by review team: None Evidence gaps &/or recommendations for future research: Source of funding: Financial assistance from European Union
Country: England Plan: Peterborough City Council 2006 Scoping Report and 2008 Core Strategy Preferred Options Report Method of appraisal: SEA (within context of SA: Used HIA-type assessment). Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in plan: NR (iii) Evidence of being implemented: NR (iv) Post-adoption evaluation: NR b) Specific issues: (i) Physical activity: Y (ii) Mental wellbeing: NR (iii) Air / noise quality etc: Y (iv) Unintentional injury: N (v) Other health: Y Specify: - access to health services - health inequalities - open space - socio-economic - healthier environments - equity issues. c) Knowledge outcome: Planners health knowledge or skills: NR d) Other outcome: NR Specify: The Core Strategy itself did not mention ‘health’ but almost entirely focuses on the question as to how to deliver economic growth. However, the SEA itself works with various health objectives and aspects. The SEA is focussed more on social & behavioural aspects. Interestingly, it is reported that Health stakeholders had the possibility to participate in the SEA process, but did not. Health comments came from non-health bodies. E.g. comments (on health and flood risk, biodiversity, accessibility, high quality living environments, healthy lifestyles) came from the Countryside Agency, Environment Agency, English Heritage and ‘Opportunity Peterborough’ (an regeneration company).
Country: England Plan: Peterborough Transport Plan 2 of January 2006 which considered 1 option for major transport schemes against a ‘do nothing’ option. Method of appraisal: SEA Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in plan: UC (iii) Evidence of being implemented: UC (iv) Post-adoption evaluation: NR b) Specific issues: (i) Physical activity: Y (ii) Mental wellbeing: NR (iii) Air / noise quality etc: Y (iv) Unintentional injury: Y (v) Other health: Y Specify: Healthier communities & narrowing of health inequalities c) Knowledge outcome: Planners health knowledge or skills: NR d) Other outcome: NR Specify: A scoping report was released in 2004. An environmental report was prepared in 2005 and subsequently subject to consultation at the end of the same year. It includes the presentation of baseline conditions and objectives, as well as an assessment of preferred schemes. Two alternatives were considered; and ‘preferred schemes’. This was followed up by the publication of a final SEA statement in 2006. Prepared by planning/environmental consultants with main focus on biophysical aspects. Presentation of baseline information was done in descriptive manner, with no maps and impacts limited to short, medium & long term. A lot of the baseline data provided on the different aspects subsequently did not appear to have been used later in assessment and the connection between baseline data and assessment is vague.
No explicit mention that decision were influenced by health related aspects of this SEA, although it is a requirement of the Directive that the influence of the overall SEA should be detailed. The authors suggest therefore that it is “probable” that health considerations had an impact. Country: Wales Plan: Scoping Report and the Key Issues and Strategy Options for Wrexham 2006 Local Development Plan Method of appraisal: SA (& associated rapid HIA of March 2008) Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in plan: NR (iii) Evidence of implemented: NR (iv) Post-adoption evaluation: NR b) Specific outcomes: (i) Physical activity: Y (ii) Mental wellbeing: NR (iii) Air / noise quality etc: Y (iv) Unintentional injury: Y (v) health: Y Specify: - access to health services - health inequalities - open space - The plan explicitly mentions health numerous particularly in the context of health services provisions. Relevant health background documents are listed, including the local 2004 community strategy and the Health, Social Case and strategy. Furthermore, it states that based on the outcomes of the sustainability appraisal, a separate ‘rapid HIA’ is to be prepared. A Council Health Promotion Team and a Health Body were involved in preparation of the SA, whilst the HIA was prepared by the Welsh HIA Support Unit and
- healthier environments - equity issues. c) Knowledge outcome: Planners health knowledge or skills: NR d) Other outcome: NR Specify: Wrexham Borough Council. The SA considered social and behavioural aspects and used quantitative and qualitative methods. A lot of the baseline data provided on the different aspects subsequently did not appear to have been used later in and the connection between baseline data and assessment is vague. This suggests that HIA was not used in a fully proactive manner in order to influence the choice of preferred options, but rather in an ex-post manner for mitigating effects of developments that were already decided upon. Country : Germany Setting: Population: 1 M inhabitants on 4000km2 in Lower Saxony Equity: Plan: Regional plan of Western Saxony 2008 Method of appraisal: SEA Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in plan: unclear (iii) Evidence of being implemented: unclear (iv) Post-adoption evaluation: unclear - general comment on the fact that SEA refers to monitoring programme. No SEA specific monitoring system identified. Health stakeholders can participate in SEA Authors thinks that the SEA has influenced decision-making, “Probably fair to say” that the considerations of health in SEA have an impact on final However, impact likely to have been modest (based on other making
b) Specific issues: (i) Physical activity: Y (ii) Mental wellbeing: N/R (iii) Air / noise quality etc: Y (iv) Unintentional injury: No evidence (v) Other health: Y Specify: access to open space c) Knowledge outcome: Planners health knowledge or skills: N/R d) outcome: N/R Specify: research results by same authors). Country : Germany Setting: urban - Leipzig Population: 50000 inhabitants on 300km2 Equity Plan: draft local statutory land use plan of Leipzig 2005 Method of appraisal: SEA Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in plan: unclear (iii) Evidence of being implemented: unclear (iv) Post-adoption evaluation: unclear - general comment on the fact that SEA refers to monitoring programme. No SEA specific monitoring system identified. b) Specific issues: (i) Physical activity: Y (ii) Mental wellbeing: N/R (iii) Air / noise quality etc: Y (iv) Unintentional injury: No evidence (v) Other health: Y Consultation still under way at time of writing Health stakeholders can participate in SEA but not sure if they did here. Authors thinks that the SEA has influenced “Probably fair to say” that the considerations of health in SEA have an impact on final decision-making However, impact likely to have been modest (based on
details Population and setting Plan details and method of appraisal Outcomes assessed* Results Notes Authors France, C. Year: 2004 Citation: Environmental Impact Assessment Review 24 (2004) 189–198 Aim of study: The extent to which the health care sector and land-use planners can work together to incorporate health issues into a strategic land-use planning document. design: Review of single case study. Quality score: + External validity + Country: England Setting (eg urban/rural) Urban/ rural mix Population: (size , characteristics…) Cambridgeshire County Plan: Review of adopted Cambridgeshire Structure Plan 1991-2006 and to emerging revised Structure Plan Method of appraisal: HIA (termed HIR- Health Impact Review) Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in plan: Y (iii) Evidence of being implemented: NR (iv) Post-adoption evaluation: NR b) Specific issues: (i) Physical activity: Y (ii) Mental wellbeing: NR (iii) Air / noise quality etc: Y (iv) Unintentional injury: Y (v) Other health: Y Specify: - supportive communities - housing & fuel poverty - inequality (including disability, elderly, unemployed) - public transport - flooding - jobs c) Knowledge outcome: Planners health knowledge or skills: NR d) Other outcome: Y/N Specify: The HIA derived relevant objectives for health & compared against plan policies: “the detailed matrices comparing the 13 objectives against the policies allowed analysis of the potential health benefits and negative health impacts that could arise from the Structure Plan. Through this analysis, it was found that the Structure Plan went some way towards addressing the wider determinants of health such as healthy lifestyle, employment, good quality housing, a clean safe environment and sustainable transport.” Working closely with those developing the Structure Plan meant that there was a real opportunity to input into the process and provide changes as the document emerged. Staff in land-use planning and health Limitations identified by author(s): None Limitations identified by review team: Author was part of the health authority input to HIA Evidence gaps &/or recommendations for future research: - Source of funding: Unknown
Study details Population and setting Plan details and method of appraisal Outcomes assessed* Results Notes Authors Glasgow Centre for Population Health Year: 2007 Citation: GCPH Concepts Series 3, Briefing Paper, June 2007 Aim of study: Review of a case study of participatory HIA design: Quality score: + External validity score: - Country: Scotland Setting (eg urban/rural) urban Population: (size , characteristics…) East End, Glasgow: population has some of poorest health in UK. Plan: Glasgow City Council’s draft East End Local Development Strategy Method of appraisal: HIA Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in plan: Y (iii) Evidence of implemented: NR (iv) Post-adoption evaluation: NR b) Specific issues: (i) Physical activity: NR (ii) Mental wellbeing: Y (iii) Air / noise quality etc: Y (iv) Unintentional injury: NR (v) Other health: Y Specify: - accessibility & sustainable transport - connectivity - housing choice - space c) Knowledge outcome: Planners health knowledge or skills: Y d) Other outcome: NR Specify: Many of the suggestions made by stakeholders during the assessment have been incorporated into the Local Development Strategy. The fact that planners participated in the process allowed for a fuller understanding of the thinking behind suggestions than reading a technical report would have allowed. In this case, those responsible for the Local Development Strategy benefited from both the process and the report. “This pilot Health Impact Assessment of the draft East End Local Development Strategy has been a successful exercise on several levels. The participatory process using rapid appraisal techniques and bringing together people from a variety of backgrounds Limitations identified by author(s): None Limitations identified by review team: Author prepared the HIA Evidence gaps &/or recommendations for future research: Further work is undertaken to provide information on health and its determinants for local populations. Source of funding: Unknown
Study details Population and setting Plan details and method of appraisal Outcomes assessed* Results Notes Authors Gow, A. And Dubois, L. Year: 2007 Citation: Vol. 18(9-10) NSW Public Health Bulletin Aim of study: Examines if HIA has influenced land planning work – reflects on the interim impact evaluation carried out by local planning and health authorities Study design: case study – examine and analyse documentary evidence – objective evaluation of the impact of HIA 12 months after it was carried out Quality + External validity score: + Country: Australia Setting Bungendore, urban Population: Small town, 2000 people Plan: two potential residential developments Method of appraisal: Prospective HIA carried out Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in plan: Y (iii) Evidence of being implemented: NR (iv) Post-development evaluation: NR b) Specific outcomes: (i) Physical activity: Y (ii) Mental wellbeing: Y (iii) Air / noise quality etc: Y (iv) Unintentional injury: Y (v) health: Y Specify: neighbourliness c) Knowledge outcome: Planners health knowledge or skills: N/R d) Other outcome: Specify: Interim results show between proposed and actual outputs, i.e. incorporation in plan of 9 broad recommendations covering the identified health promoting elements have been included in local environmental plan, development control and developer contribution plan. Limitations identified by author(s): Limitations identified by review team: not much details on exactly what recommendations from HIA have been included in plans, but this is really only a summary. Evidence gaps &/or recommendations for future research: more similar case studies with impact evaluation. Source of funding: No reference to funding
Study details Population and setting Plan details and method of appraisal Outcomes assessed* Results Notes Authors S., Parry, N., Rimmington, B. Year: 2004 Citation: Environmental Impact Assessment Review 24 (2004) 255–267. 2004 Aim of study: A critical reflection upon the experience of undertaking a comprehensive and participatory health impact assessment in Sheffield’s East End. Study design: Review of process & outcome of participatory HIA, plus post adoption evaluation Quality score: + External validity score: + Country: England Setting (eg Unknown, but likely mix of urban & rural Population: (size, characteristics…) Parts of Rotherham & Sheffield within the M1 motorway corridor Plan: Planning Study to inform consultation process on the M1 Corridor Strategic Economic Zone (Objective 1 investment programme). Method of appraisal: HIA Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in plan: Y (iii) Evidence of being implemented: Y (iv) Post-adoption evaluation: NR b) Specific issues: (i) Physical activity: NR (ii) Mental wellbeing: Y (iii) Air / noise quality etc: Y (iv) Unintentional injury: NR (v) Other health: Y Specify: - range of physical environment improvements including: traffic reduction, upgrade of local amenities, derelict land improvements - comprehensive labour market strategy - public engagement c) Knowledge outcome: Planners health knowledge or skills: NR An explicit objective of the HIA was to use it as a tool to increase participation of local communities in strategic development decisions for the area. The methodological framework used was a modification of the Merseyside guidelines with a focus on equity. The HIA process helped to articulate not only local community concerns, but also potential solutions, and that understanding and dialogue between key stakeholders had increased as a result. The final 2001 delivery plan for the M1 Corridor Strategic Economic Zone, set out requirements for individual site Integrated Implementation Plans (IIPs) to which developers have to adhere to receive Obj 1 investment. The IIPs require a ‘community development’ plan, and some additional elements on environmental and local employment issues, reflecting HIA recommendations. Post-adoption Evaluation Limitations identified by author(s): None Limitations identified by review team: Authors prepared the HIA Evidence gaps &/or recommendations for future research: Source of funding: Unknown
of paper: SEA as catalyst of healthier spatial planning Study details Population and setting Plan details and method of appraisal Outcomes assessed* Results Authors Kørnøv, L Year: 2009 Citation: EIA review 29, p. 60-65 Aim of study: Examines the inclusion of health as a formal component in impact assessment of spatial planning. Based on a documentary study of 100 environmental reports, article analyses and discusses how health impact considerations are incorporated in SEA practice in Denmark. Study design: Documentary analysis of 100 environmental reports Country: Denmark Setting urban and rural Population: N/R Equity: N/R Plan: synthesis of 100 environmental reports Method of appraisal: SEA Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in plan: NA* (iii) Evidence of being implemented: NA* (iv) Post-development evaluation: NA* b) Specific outcomes: (i) Physical activity: Y (ii) Mental wellbeing: N/R (iii) Air / quality etc: Y (iv) Unintentional injury: Y (v) Other health: Y Specify: recreation/outdoor life c) Knowledge outcome: Planners health knowledge or skills: N/R d) Other outcome: N/R Specify: In Denmark, municipal practice of SEA demonstrates: Health is included in planning assessment practice Health is interpreted in a broader sense than national guidance Aspects often included include: noise, drinking water, air pollution, recreation/outdoor life and traffic safety Both negative and positive impacts on health are assessed Assessment of human health is qualitative No reference to equity The presentation of human health impacts lacks in environmental reports (i.e. no separate heading in reports) Limitations identified by author(s): Limitations identified by review team: *NA used here as NO reference to impact of environmental reports on and policies; article only covers the outcomes assessed in environmental reports Evidence gaps &/or recommendations for future research: Source of funding: not known
Title of paper: Health impact assessment as an agent of policy change: improving the health impacts of the mayor of London’s draft transport strategy. Study details Population and setting Plan details and method of appraisal Outcomes assessed* Results Notes Authors Mindell, J., Sheridan, L., Joffe, M., H., Atkinson, S Year: 2004 Citation: Journal of Epidemiology & Community Health 2004;58:169–174 Aim of study: To review the effectiveness of the HIA on a draft transport strategy. Study design: Comparison of HIA recommendations to adopted strategy Quality score: + External validity + Country: England Setting (eg urban/rural) Inner urban Population: (size , characteristics…) Capital city with issues of equality and wealth disparities, and traffic congestion. Plan: Draft Transport Strategy Method of appraisal: Rapid prospective HIA Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in plan: Y (iii) Evidence of implemented: NR (iv) Post-adoption evaluation: NR b) Specific issues: (i) Physical activity: Y (ii) Mental wellbeing: NR (iii) Air / noise quality etc: Y (iv) Unintentional injury: Y (v) Other health: Y Specify: - social inclusion & equity in provision & pricing of public transport - community transport - integration of transport investment with economic development. c) Knowledge outcome: Planners health knowledge or skills: Y Significant changes were made to the final version of the strategy, including: Equity of access to public transport Encouragement of walking, cycling & public transport Home zones, 20mph zones & safer routes to school Commitments to consult on transport policies Some health related indicators were included for monitoring strategy The changes from the draft to the public consultation draft were definitely attributable to the HIA. Changes between the public consultation draft and the final strategy might have been attributable to other consultation responses, or such responses may have added weight to recommendations from the HIA. Transport planners at Limitations identified by author(s): None Limitations identified by review team: Authors were involved with preparation of HIA Evidence gaps &/or recommendations for future research: Source of funding: No funding
Data extraction form of paper: Strategic environment assessment in Hong Kong details Population and setting Plan details and method of appraisal Outcomes assessed* Results Notes Authors Ng, K.L., Obbard, J. P. Year: 2005 Citation: Environment International 31 Aim of study: Examines the development and application of SEA process in the planning framework of Hong Kong and evaluates 2 strategic planning case studies. Study design: case study, methodology not described Quality score: + Country: Hong Kong Setting urban with rural spaces Population: 6.4 M Equity: N/R Plan: Territorial development strategic review Method of appraisal: SEA Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in plan: unclear (iii) Evidence of implemented: N/R (iv) Post-development evaluation: N/R b) Specific outcomes: (i) Physical activity: N/R (ii) Mental wellbeing: N/R (iii) Air / noise quality etc: Y (iv) Unintentional injury: N/R (v) health: Y Specify: Overloading of sewage infrastructure c) Knowledge outcome: Planners health knowledge or skills: N/R d) outcome: N/R Specify: SEA predicted human health related residual impacts in TDS: Proposed that some of the identified problems could be mitigated if further resources were applied Others were identified as requiring policy modifications as no mitigation measures feasible But SEA conducted for the development options, but not during formulation of the options SEA application compromised in its ability to achieve sustainable development Findings of SEA were not seriously considered Limitations identified by author(s): Limitations identified by review team: does not explain clearly if health outcomes were incorporated in plan, it only states that SEA did consider health and that some recommendations were taken into account in plan conclusions in study seem contradictory at time (See results) Evidence gaps &/or recommendations for future research: Source of funding: not known
development proposals Same as above Plan: Third comprehensive transport study Method of appraisal: SEA Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in plan: Y NB: but see results (iii) Evidence of being implemented: unclear (iv) Post-development evaluation: N/R b) Specific outcomes: (i) Physical activity: N/R (ii) Mental wellbeing: N/R (iii) Air / noise quality etc: Y (iv) Unintentional injury: N/R (v) Other health: Y Specify: Cultural heritage c) Knowledge outcome: Planners health knowledge or skills: N/R d) outcome: N/R Specify: SEA identified air quality degradation as well as noise pollution SEA applied too late in decision-making process, once development options were already formulated and sanctioned to proceed SEA has been development led, failure to apply SEA at formulation stage has resulted in limited development alternatives being explored to avoid environmental degradation (air and noise) SEA has helped to integrate and balance environmental concerns with the ambitious land use and transport development demands of a prosperous and growing population but SEA limited:
of paper: Equality and diversity: improving planning outcomes for the whole of the community Study details Population and setting Project details and method of appraisal Outcomes assessed* Results Notes Authors Planning Advisory Service Year: 2008 Citation: IDeA September 2008 Aim of study: Identifying good practice in planning for equality and diversity Study design: Review of selected case studies (one relevant) Quality score: + External validity score: + Country: England Setting (e.g. urban/rural) Inner urban city Population: (size, characteristics…) LB Tower Hamlets- high %: of young people born Asian Unemployed with ethnic minorities over represented Also below national average educational achievement rate. Project: Draft Whitechapel Masterplan, November 2006 Method of appraisal: EqIA (Equality Impact Assessment) to inform SA (Sustainability Appraisal) Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in plan: Y (iii) Evidence of implemented: NR (iv) Post-adoption evaluation: NR b) Specific issues: (i) Physical activity: Y (ii) Mental wellbeing: Y (iii) Air / noise quality etc: NR (iv) Unintentional injury: Y (v) Other health: Y Specify: - outdoor spaces & indoor leisure - accessibility c) Knowledge outcome: Planners health knowledge or skills: Y d) outcome: Y Specify: -Monitoring of equality indicators -using design guidance to ensure open spaces The Equality Standard Local Government requires a baseline of monitoring data and an analysis of this to evidence equality impact, so this case study constitutes good practice. The results of the EqIA highlighted several significant targeted actions in the masterplan which arose from considering ways of reducing inequality: improved outdoor spaces and indoor leisure facilities with a particular benefit for those with ill-health and opportunities to encourage greater participation in these spaces and facilities for minority ethnic communities - a new pedestrian crossing and improvements to the Limitations identified by author(s): Had to limit to focused process impacts”. Limitations identified by review team: No methodology. Information presented by LPA officers - not corroborated. Evidence gaps &/or recommendations for future research: Source of funding: Unknown, presumably PAS
Data extraction form Title of paper: Greater Christchurch Draft Urban Development Strategy 2005 details Population and setting Plan details and method of appraisal Outcomes assessed* Results Authors Stevenson, A., Banswell, K. and Pink, R. Year: 2007 Citation: Vol. 18 (9-10), NSW Public Health Bulletin Aim of study: Description of the Greater Christchurch Urban Development Strategy 2005’s HIA: its development and implementation and the results from the process evaluation. Examines whether the HIA is a useful tool for local government policy Country: New Zealand Setting urban Population: Greater Christchurch Equity: maori involvement in process Plan: Greater Christchurch Urban Development Strategy 2005 Method of appraisal: HIA Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in proposal: Y (iii) Evidence of being implemented: unclear (iv) Post-development evaluation: unclear (= process and impact evaluation) b) Specific outcomes: (i) Physical activity: Y (ii) Mental wellbeing: unclear (iii) Air / noise quality etc: Y (iv) Unintentional injury: N/R (v) health: Y Specify: Hhousing and transport - social connectedness c) Knowledge outcome: Planners health knowledge or skills: N/R Process was supported by those involved (3250 respondents), strong support for interdisciplinarity and limit in what could be achieved due to limited resources (staff, money, time). Impact: Greater Christchurch Urban Development Strategy has now a dedicated section on health and well-being acknowledging importance of social and environmental determinants of health Participation of maori increased. HIA directed the focus on the strategy on quality of life outcomes. HIA has highlighted the significance of Limitations identified by author(s): Limitations identified by review team: Evidence gaps &/or recommendations for future research Source of funding: N/R
design: Case study – report on process evaluation carried out, document analysis for impact evaluation and Quality score: + External validity score: + d) outcome: Specify: statutory and collective responsibilities relating to health and social outcomes within principles of planning legislation HIA has identified that strategy has a role to deliver on health and social outcomes by informing both local and central government policies (housing, supporting active travel, social connectedness and reduce gaps in health inequalities
Data extraction form Title of paper: Greater Granville Regeneration Strategy Study details Population and setting Plan details and method of appraisal Outcomes assessed* Results Notes Authors Stevenson, A., Banswell, K. and Pink, R. Year: 2007 Citation: Vol. 18 (9-10), NSW Public Health Bulletin Aim of study: Description of the impact of the Greater Granville Regeneration Strategy’s HIA: identification of the positive and negative health impacts Study design: Country: Australia Setting urban Population: Greater Granville’s residents, 1500 tenants including 300 Aboriginals Equity: Aboriginals Plan: Greater Granville regeneration strategy Method of appraisal: HIA Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in proposal: Y (iii) Evidence of being implemented: unclear (iv) Post-development evaluation: NR b) Specific outcomes: (i) Physical activity: Y (ii) Mental wellbeing: Y (iii) Air / noise quality etc: N/R (iv) Unintentional injury: N/R (v) Other health: Y Specify: access to services, urban design and housing: availability and control over housing c) Knowledge outcome: Planners health knowledge or skills: N/R d) outcome: N/R Specify: Health impacts of the regeneration strategy have been identified by the HIA Outcomes: of recommendations changes to new bus timetables to meet needs with NSW department o housing to see if HIA can be used as a tool for broader policy applications at the development phase of housing regeneration partnership agreement with key stakeholders to progress implementation of HIA recommendations policy drivers that WILL Limitations identified by author(s): Limitations identified by review team: Evidence gaps &/or recommendations for future research: Not sure if details of the outcomes have been implemented Future evaluation should consider the full extent of the HIA outcomes relative to the resource investment. Source of funding: N/R
Data extraction form Title of paper: T The Effectiveness of Health Impact Assessment, Scope and limitations of supporting decision-making in Europe. Study details Population and setting Plan details and method of appraisal Outcomes assessed* Results Notes Authors Wismar, M., Blau, J., Ernst, K., Figueras, J. Eds Year: 2007 Citation: World Health Organization 2007, on behalf of the European Observatory on Health Systems and Policies. Aim of study: To map HIA use in EU & evaluate its effectiveness. Study design: Literature review & then map HIA use across EU. Review effectiveness of 17 HIA case studies (3 relevant to this Review) Three individual plans across EU – all analysed by HIA or a form of HIA: See individual case studies below Authors’ Overview: Most of 17 HIAs in the case studies proved effective in some way, but the magnitude of influence varied from “direct effectiveness” (led to modification), “general effectiveness” (no modification, but links understood & awareness raised), “opportunistic effectiveness” (HIA done in support of proposal), or “no effectiveness”. Limitations identified by author(s): Unrepresentative as only limited number of HIA studied, given the coverage. Limitations identified by review team: Case studies chosen for inclusion on effectiveness as deemed by individual country researchers (not by authors). Evidence gaps &/or recommendations for future research: -HIA predictions need improving -Link sectors who are involved in Source of funding: European Union Public Health Work Programme
Quality score: + External validity score: ++ Country: Ireland Setting (eg urban/rural) Urban Population: (size , characteristics…) Four Air Quality Management in Belfast. Plan: Draft Air Quality Management Plan (AQMP) Method of appraisal: HIA Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in plan: Y (iii) Evidence of implemented: NR (iv) Post-adoption evaluation: NR b) Specific issues: (i) Physical activity: NR (ii) Mental wellbeing: NR (iii) Air / noise quality etc: Y (iv) Unintentional injury: NR (v) Other health: NR Specify: c) Knowledge outcome: Planners health knowledge or skills: NR d) Other outcome: Y Specify: Belfast is a recognised WHO ‘Healthy City’. The Council was one of the main drivers for the HIA and therefore this is a good example of the value that HIA can offer in the development of plans or policies. The City Council was aware that measures proposed by other councils during the development of Air Quality Action Plans were not always effective and in some cases could actually contribute to negative impacts. Effectiveness General: it was too early to tell, as the process had not reached its conclusion, and made without access to all the facts,
Plan would have addressed air quality generally but the HIA highlighted that the health in these 4 areas was worse anyway because of disadvantage.” Community: This was mixed. Those who reported direct effectiveness identified clear links between suggestions made at the community workshops and actions outlined in the final Action Plan. For other measures of effectiveness, there was a general view that the HIA had impacted positively on working partnerships between different organizations. Country: NL Setting Leiden, urban Population: 118000 (size , characteristics Plan: Plan for restructuring an industrial area into a residential area Method of appraisal: Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in plan: Y Some but limited Health Effectiveness: HIA had a general effect on health by increasing the consciousness of decision-makers Limitations identified by author(s): HIA must be introduced clearly in the policy cycle to avoid making it another burden HIA should be integrated with other instruments
Equity: lower incomes, people with mobility problems HIA – Health effect screening (= HIA rapid appraisal) (iii) Evidence of being implemented: unclear (iv) Post-adoption evaluation: unclear b) Specific issues: (i) Physical activity: Y (ii) Mental wellbeing: Y (iii) Air / noise quality etc: Y (iv) Unintentional injury: unclear (v) Other health: N/R Specify: c) Knowledge outcome: Planners health knowledge or skills: N/R d) Other outcome: N/R Specify: Equity: no special mention to equity in HIA Community effectiveness: modest achievement, better relationship with local civil servants but passive involvement at later stages of HIA led to new thoughts on health promotion (eg physical activity), but little impact on health protection (eg polluted soil, air pollution) Country: Finland Setting (eg urban/rural) Jyväskylä in city and 6700 in Korteniitty (size , characteristics Plan: detailed plan for Korteniitty Method of appraisal: HIA and social impact= Prospective Participative social impact assessment Outcomes measured: a) Process outcomes: (i) Health outcomes considered: Y (ii) Health recommendations incorporated in plan: Y (iii) Evidence of being implemented: unclear (iv) Post-adoption evaluation: unclear b) Specific issues: (i) Physical activity: Y (ii) Mental wellbeing: N/R SIA direct effects on the plan were difficult to distinguish: However SIA supported discussion, planning and decision-making Provided residents with information From plan summary report: Positive impact on various aspects Limitations identified by review team: Too few interviews and no triangulation to g et a sufficient analysis
(iii) Air / quality etc: NA (iv) Unintentional injury: Y (v) Other health: N/R Specify: c) Knowledge outcome: Planners health knowledge or skills: Y d) Other outcome: N/R Specify: (bridges, buildings, playgrounds, day care...) But this is questioned by interviewee: who thought that SIA had no effect on the planning decision Health effectiveness: No strong evidence suggested that SIA had effect on health effectiveness Equity effectiveness: SIA had a direct effect as the plan was modified and adjusted accordingly (expanding school playing but this is contested by another interviewee Community effectiveness: contradictory evidence again here However change in culture and practice in SIA