2. Methods, Selection of Cases and Framework for HIA Case Evaluation
|1||Conceptual understanding of health|
What definition of health was considered in appraisal?
Has the definition of health adopted been explicated and agreed on/discussed by the steering committee?
Is the definition of health outlined within the circulated documents? Where is it described in the process development?
|2||Main concern addressed|
What is the object of assessment? Are unknown impacts considered by the HIA?
Identification of indirect impacts, focusing the determinants of health? Consideration of differently affected subgroups from an equity and social justice point of view? Prediction of direct impact on physical health stemming from defined environmental risks?
When is the assessment made in relation to the decisional process? Is the area smaller/larger than a municipality? Is the assessment high/medium/low resource-consuming? Is the proponent from a government institution? Local/regional/national?
|4||Integration of IA types|
Does the assessment cover more than one different kind of impact (i.e., health and environment)? Are cross-cutting themes related to impacts combined in one process (i.e., sustainability evaluation)? Are equity or social justice assessed? Are relations with policies/plans affecting widespread health and well-being determinants reviewed/mentioned/assessed?
|5||Involvement of stakeholders|
Is there any kind of participation? When? Who was involved? Local government/authorities, advisory authorities, local communities, subgroups of society?
|6||Type of evidence|
Qualitative data? A mix of qualitative and quantitative? What kind of health data are used: literature, toxicology-based, epidemiology-based, on routine or study sample data, interviews, questionnaire?
Information provided: magnitude of impact, baseline health status, risk measures?
|7||Added value of HIA |
What is the assessment carried out for? Institutional decision-making support (evaluating interventions, prospective assessment of projects), advocacy by subgroups (influencing decision and implementation, understand and contribute to decision-making)?
Is the process voluntary or required by regulation (undertaken by the proponent, decision-maker, external organization, community-led)? Is the decisional component included in the process? Are conflicting parties included?
Is there a monitoring phase? On the implementation of the recommendations? On the reduction of impact? Other aims?
3. Results and Discussion
3.1. State of the Art on Health Impact Assessment
|Key Dimensions||Study Reference|
|Bianchi et al., 2006 ||Adam et al., 2014 ||Linzalone et al., 2014 |
|1. Mode l of health||Biomedical model
||Biomedical model and exploration of socioeconomic determinants of health
||Biomedical model and exploration of socioeconomic determinants of health
|2. Focus of HIA|
|3. Application level|
|6. Type of evidence|
|7. Added value to the proposal|
3.2. Health Assessment in EIA Reports
3.3. Health Issues in SEA Reports
- Absence/lack of characterization of the environmental factors that directly and/or indirectly affect the health of exposed people.
- Absence/lack of identification and characterization of the potential risks associated with the actions contained in the plan/program.
- Absence/poor evaluation of the effects on health deriving from the implementation of plan/program.
- Lack of consideration for prevention and reduction of effects on health.
3.4. Piedmont Region Case Study. Environmental Impact Assessment of the New High-Speed Railway Turin-Lyon
- The final project approval was decided by an EIA procedure and HIA was required as enclosed requirement, to monitor impact during and after their occurrence, over a long period of time.
- The preventive knowledge of the health status of the population did not inform the HIA screening phase (the decision about the feasibility of the Project was made a priori and independently from the evaluation of the health status of the population at baseline).
3.5. Apulia Region Case-Study. Gaps in Preventing Environmental-Health Risk from ILVA Plant
- Pre-screening for the definition of a base of evidence needs and the role of the local environmental and health institutions.
- Screening to provide the systematic analysis of current evidence on the extent of environmental pollution as well as of local health descriptors.
- The scoping and assessment phases were led by the ARPA of the Apulia Region, the regional Health Agency and the Taranto health local unit. The VDS consisted in the independent parallel evaluation of industry-related health outcomes (mortality, cancer registry, hospital discharge data) and risk assessment based on the EPA residual risk approach .
- A monitoring activity is due yearly according to the approved regulations (Integrated Environmental Authorization), which include a communication report.
4. Discussion and Analysis
4.1. Definition of a Model of Health and Outcome Assessment
4.2. Focus of Assessment and Definition of Methods
4.3. Positioning of HIA and Application Level Are Key Issues in Selecting Stakeholders
4.4. HIA Integration in EIA and SEA
4.5. Stakeholder Involvement, Timing of Participation and Opportunity to Add Value
Conflicts of Interest
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