Development and Health Impact Assessment

Hisashi Ogawa
Disclaimer: The views expressed in this paper/presentation are the views of the author and do not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. Terminology used may not necessarily be consistent with ADB official terms.

Outline
Brief Guides to Health Impact Assessment
Development of Health Impact Assessment in the Asia-Pacific Region

Health Impact Assessment in Transport Sector

Brief Guides to Health Impact Assessment

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

Sustainable Development and Health*

Economic

Environmental

Social

Health Impact
* WHO Definition: Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.

Concepts of HIA Determinants of Health

1. Determinants related to the individual: genetic, biological, lifestyle/behavioral and/or circumstantial. 2. Social and environmental determinants: physical, community conditions and/or economic/financial. 3. Institutional determinants: the capacity, capabilities and jurisdiction of public sector institutions and the wider public policy framework supporting the services they provide.
From IAIA Special Publication Series No. 5 Health Impact Assessment: International Best Practice Principles, September 2006

What is a health impact assessment (HIA)?

Health impact assessment (HIA) is a combination of procedures, methods, and tools used to evaluate the potential health effects of a policy, program or project. Using qualitative, quantitative and participatory techniques, HIA aims to produce recommendations that will help decision-makers and other stakeholders make choices about alternatives and improvements to prevent disease/injury and to actively promote health.
From www.who.int/hia/en

General HIA Process

1. Screening 2. Scoping 3. Full scale HIA 4. Public engagement and dialogue 5. Appraisal of the HIA report 6. Establishment of a framework for intersectoral action 7. Negotiation of resource allocations for health safeguard measures 8. Monitoring
From IAIA Special Publication Series No. 5

Examples of HIA Methods

Collection and analysis of appropriate secondary data 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 Information Systems. Review of relevant scientific and gray literature.
From IAIA Special Publication Series No. 5

In practice, HIAs are applied

Within EIA (Environmental Impact Assessment) system in countries
To priority environmental hazards in countries To policies and plans in different development sectors

Development of Health Impact Assessment in the Asia-Pacific Region

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

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

Development of EIA systems in developing countries, 1980s-early 1990s

ADBs HIA guidelines, Nov. 1992

WHO Regional Workshop on EHIA, Nov. 1993

WHO/Com Sec EHIA workshop, 1995

National guidelines on EHIA, 1995-2000: Malaysia, Papua New Guinea, Philippines

1980

1990

2000

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

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

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

Global HIA of Environmental and Occupational Risks**, WHR 2002

Regional Forum on Environment and Health in Southeast and East Asian Countries, 2004Present

Environmental Burden of Disease estimates**, 2006 Regional Forums Thematic Working Group on HIA, 2010 Asia-Pacific HIA Conference, 2007Present National strategy for EHIA, Solomon Islands, 2009

WHO Regional Workshop on HIA of Environmental Hazards, Aug. 2003

WHO Bulletin, ADB Primer, 2003

2000

2010

HIA of Priority Environmental Hazards in Countries

China, 2001 Environment and Peoples Health (urban air pollution; water pollution; and pollution from small industries) Fiji, 2003 An Assessment of Health Impacts from Environmental Hazards (water supply; air pollution; and chemical and hazardous waste) Mongolia, 2003 Assessment of Health Impacts from Environmental Hazards (air pollution, water contamination)

Exposure-effect relationships for air pollution: log (annual mortality rate of respiratory diseases)=0.3033 log(SO2)+0.964 log (annual mortality rate of cardiovascular diseases)=1.991 log(SO2)+2.7426 log (annual mortality rate of lung cancer)=0.5722 log(SO2)+0.3149

Excess deaths due to air pollution:

127,000 from respiratory diseases 205,000 from cardiovascular diseases 44,000 from lung cancer 376,000 in total Economic loss:
US$10.3 billion-19.3 billion (1.1%-2.0% of GDP)

Composite Health Risk Index, by Province in China, 2001

(indoor air quality, outdoor air quality, drinking water quality, malnutrition and health services indices)

HIA of Specific Environmental Hazards

Malaysia, 2004 A Study of Health Impact and Risk Assessment of Air Pollution in Klang Valley Mongolia, 2004 Health Risk Assessment of Indoor Air Pollution in Ulaanbaatar Philippines, 2004 Public Health Monitoring (A Study under the Metro Manila Air Quality Improvement Sector Development Programme) China, 2005 Climate Change, Climate Variability and Health Lao PDR, 2007 Investigation of Indoor Air Pollution and Relationship to Housing Characteristics and Health Effects

Public Health Monitoring Study on Metro Manila Air Quality GIS important in identifying exposure risk areas in MMLA

Public Health Monitoring Study on Metro Manila Air Quality Motor vehicles are the major source of PM pollution in MMLA
Manila Observatory, Quezon CIty (Mixed, Dry Season)

Apportionment by station
Good Shepherd Retreat House, Antipolo (Background, Dry Season) Biomass: 0.134 0.068 Oil: 0.089 0.062 Traffic: 0.523 0.159

National Printing Office, Quezon CIty (Traffic, Dry Season)

Biomass: 0.109 0.096

Biomass: 0.054 0.033 Sulphate: 0.06 0.024

Sulphate: 0.07 0.021

Traffic: 0.749 0.095

Sulphate: 0.18 0.102

Traffic: 0.846 0.055

Philippine General Hospital, Manila (Commercial, Dry Season)

Barangay Mapulang Lupa, Valenzuela (Industrial, Dry Season)

BF Almanza, Las Pinas (Residential, Dry Season)

Biomass: 0.109 0.096 Lead: 0 0 Seasalt: 0.003 0

ATENEO

Oil: 0.024 0.003 Soil: 0.016 0.012

GOOD SHEPHERD (ANTIPOLO)

Biomass: 0.134 0.068 Lead: 0 0 Seasalt: 0.016 0.01 Tin: 0 0 Nitrate: 0.016 0.015 Traf f ic: 0.523 0.159 Oil: 0.089 0.062 Soil: 0.027 0.032 Zinc: 0.004 0.006 Construction: 0.005 0.009 Sulphate: 0.18 0.102

EDSA (NATL. PRINTING OFF.)

Biomass: 0.054 0.033 Lead: 0.001 0 Seasalt: 0.002 0 Tin: 0.002 0.001 Oil: 0.01 0.001 Soil: 0.006 0.002

Biomass: Zinc: 0.001 0 0.049 0.045 Tin: 0.005 0.003 Construction: 0.006 0.007
Nitrate: 0.013 0.012 Traffic: 0.749 0.095 Sulphate: 0.07 0.021

Biomass: 0.001 0 Zinc: 0.056 0.036

Construction: 0.007 0.002 Sulphate: 0.06 0.024

Sulphate: 0.065 0.03

Biomass: 0.216 0.139

Nitrate: 0.006 0.001 Traffic: 0.846 0.055

Sulphate: 0.116 0.056 Traffic: 0.6 0.132

Traffic: 0.823 0.056

Sulphate: 0.102 0.021

Traffic: 0.725 0.098

Biomass: 0.049 0.045 Lead: 0 0 Seasalt: 0.003 0.003 Tin: 0.002 0.001 Nitrate: 0.011 0.008

PGH

Oil: 0.018 0.006 Soil: 0.008 0.008 Zinc: 0.003 0.002 Construction: 0.013 0.016 Sulphate: 0.065 0.03

BGY. MAPULANG LUPA (VALZ)

Biomass: 0.216 0.139 Lead: 0 0 Seasalt: 0.002 0.001 Tin: 0.005 0.003 Nitrate: 0.01 0.006 Traf f ic: 0.6 0.132 Oil: 0.034 0.013 Soil: 0.011 0.007 Zinc: 0.004 0.003 Construction: 0.01 0.009 Sulphate: 0.102 0.021

BF ALMANZA, LAS PINAS

Biomass: 0.056 0.036 Lead: 0 0 Seasalt: 0.008 0.005 Tin: 0.001 0.002 Nitrate: 0.032 0.021 Traffic: 0.725 0.098 Oil: 0.022 0.006 Soil: 0.028 0.008 Zinc: 0.005 0.002 Construction: 0.001 0.002 Sulphate: 0.116 0.056

Traffic: 0.823 0.056

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

HIA of Environmental Hazards in Development 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 air pollution; noise; road traffic injuries; and physical activity) Viet Nam, 2005 Health and Environmental Impacts of Pesticide Application Regional Workshop on Health and Environment Linkages (HELI) in Agriculture, 2006

The oil consumption (100 million tons)

5 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0 0.29

The oil consumption of transport The total consumption

3.2

4.5

2.56 2.2 1.6 1.38 0.55

1995

2000

2010

2020

The oil consumption proportion of traffic in China

The proportion of motor vehicle emission to the whole air pollution was 79% in 2005, and is increasing.

Lead poisoning in children is also common in China. However, after 6 months from the compulsory use of unleaded gasoline in 2000, the proportion of the lead poisoning in children aged 1-6 years decreased by about 13%.
Vehicle exhaust has become one of the main air pollution sources in many big cities

Others 10.7% Industry 10.7% Construction 3.5%

Transport 23.5%

Social activ ities 51.6%

Traffic policemen who are exposed to noise of 73.8 76.8dB(A) showed that the incidence of hearing impairment was 23.8%, which was nearly three times higher than general population.

The percentage of urban noise sources in China

600000 550000 500000 450000 400000 350000 300000 250000 200000 150000 100000 50000 0

40 35 30 25 20 15 10 5 0 197819811984198719901993199619992002

The number of deaths The number of injuries

197819811984198719901993199619992002
The number of casualties in road traffic accident

In 2002, the number of deaths on roads in China represented 9.3% of the total number of deaths in the world. The estimated annual cost of traffic injuries in China is equivalent to US$12.5 billion, almost four times the amount of the total public health services budget for the country.

The direct economic cost (0.1 billion Yuan)

Use and Benefits of HIA of Environmental Hazards

HIA of environmental hazards provides information for prioritizing environmental health problems and locations of the problems in the country, the Region, the area, or the development sector assessed. It, therefore, supports the arguments for recommending policy options.

Institution and Policy Development

EHIA Division of EHS in the Philippine DOH 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 in Cambodia and Viet Nam Proposed HIA Act in Republic of Korea

Health Impact Assessment in Transport Sector

Vehicle technologies: cleaner engine & fuel, and safety devices Driver-Pressure Motorization Increased private motor vehicles

Road systems and design

Traffic demand management

Environmental control & monitoring

Lifestyle change

State-Exposure Dependency on motor vehicles Physical inactivity

Health Effect Obesity

Air pollution (PM, NOx, O3) Increased population Urbanization GHG emissions Noise

Cardiovascular diseases Respiratory diseases

Increased commuting distance

Decreased use of public transport Climate change Increased temperature Rainfall change Built environment

Traffic crash

Hearing impairment
Injury Social inclusion and well-being Heat-related; vector-, water-, and food-borne diseases

Smoking in public transport & places

Barriers in transport
Increased heat wave, water shortage, rainfall, flooding

Health Effects of Transport

Motorized Transport causes Air pollution respiratory and cardiovascular disease and deaths Traffic accidents - injuries and deaths Noise and vibration hearing impairment and psychological 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 other NCDs No air pollution, noise/vibration, traffic congestion Vulnerable to road traffic injuries

Bicycle, Walk Non-Motorized Transport

Physical inactivity is a risk factor for obesity, hypertension, cardiovascular and other non-communicable diseases 30 minutes of bicycling/walking a day can halve the risk of heart disease Switching from car to bicycle to travel 15 km increases life by 7 months recent study in the Netherlands*
Gain in life days/months per person Air pollution Traffic accidents Physical activity -21 days (-0.8 to -40 days) -7 days (-5 to -9 days) +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.

Environmentally Sustainable and Healthy Urban Transport (ESHUT)

Overall objective To promote a win-win, cobenefit strategy (reducing carbon footprint and promoting and protecting health) to build healthy urban transport system

Specific objectives To empower Asian cities to:

Promote non-motorized transport (e.g. walking and cycling) Provide efficient public transport system, including improvement in connectivity and access Reduce use of private motor vehicles Provide smoking- and barrier-free transport environments

Examples of ESHUT Activities

Bicycle use support Pedestrianization Bus rapid transport and mass rapid transit Increased connectivity at stations/stops Transport demand management Barrier-free and safe roads, walkways and public transport Health-promoting and hygienic public transport

Example: Bicycle City Changwon

Changwon City, Gyeongnam-do is one of Healthy Cities in Republic of Korea and promotes a pro-bike policy (infrastructure for bicycle use, education to citizens, public bicycle rental system, etc.) since 2006. In 2011, WHO commissioned a study to assess the health benefits of this policy as part of ESHUT (Environmentally Sustainable and Healthy Urban Transport)

Changwon Pro-bike Policy

The number of bicycles has increased to 12,138 or 0.79 per household The bike rental terminals are situated at 163 locations with 1,807 rental bicycles The factory workers who use bicycles to work has increased from 4.8% to 7.3% (66% increase)

Pro-bike Policy HIA Study*

Increased physical activities
HEAT (Health Economic Assessment Tool for Bicycle 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 pollution

AirQ (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

Main Results Physical Activity*

*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

Traffic Accident Mortality in Changwon

17.8 15.7

12.7

13.2 12.3

2005

2006

2007 Age Standardized Death Rate (per 100,000)

2008

2009

Traffic Accident Deaths by Type

Air Pollution
80 12 70 10 60

8
50

PM10: ug/m3 40 O3: ppb

NO2: ppb CO: 100 ppb SO2: ppb

30 4 20 2 10

0 1999 2000 2001 2002 2003 NO2 2004 2005 O3 2006 CO 2007 2008 2009 Pm10 SO2

Attributable Deaths due to PM10

Future Prospects
More developing countries in Asia and the Pacific to develop systems and strengthen capacity for HIA in EIA Further experiences in applying HIA to social and economic determinants Country-level (or city-level) HIAs of priority environmental hazards and of development sectors (transport, housing, etc.) Further development of national HIA policies and institutions, if appropriate, through TWG activities