Health Impact Assessment to Promote Urban Health: A Trans-Disciplinary Case Study in Strasbourg, France

Round 1

Reviewer 1 Report (Previous Reviewer 3)

In the introduction, I feel it is important that authors present a more concise background information focusing on the global debates on HIA, road and transport infrastructure before delving into that of the study area- Strasbourg, France.

In the materials and method section, I suggest that authors present a table(s) or figure(s) to further support the results of the analyses on outdoor air quality, noise road accidents etc presented. It will enhance the understanding of your readers.

Before the conclusion section, kindly present a sub-section heading "limitations of the study ' and "areas for further studies".

Thank you.

Author Response

Dear Reviewer 1,

As the Guest Editor has suggested, we have corrected our text according to his suggestions, which bring together the observations of all 5 reviewers.

We have also added an initial paragraph, in order to follow your suggestion about the "concise background information focusing on the global debates on HIA, road and transport infrastructure before delving into that of the study area- Strasbourg, France".

This new paragraph reads thus and we hope it is to your satisfaction. Best regards. The Authors

"The crucial connection between transportation and health has been emphasized for many years by international agencies including the United Nations Economic Commission for Europe (UNECE) and the World Health Organization (WHO), through initiatives such as the Transport, Health and Environment Pan-European Programme (THE PEP). However, at local level there is little consensus about how tools such as Health Impact Assessment (HIA) might be used to investigate and/or improve road projects likely to have an impact on health. This article suggests the detailed analysis of a case study in France as a way forward. As HIA is only rarely used to investigate the building of new roads, this approach may prove useful for other projects or settings."

Reviewer 2 Report (Previous Reviewer 7)

Everything ok!

Author Response

Dear Reviewer 2, many thanks for your positive and encouraging review of our work.

As the Guest Editor has suggested, we have corrected our text according to his suggestions, which bring together the observations of all 5 reviewers.

Very best regards,

The Authors

Reviewer 3 Report (Previous Reviewer 5)

1.- The introduction breaks down the particular case of Strasbourg very well. However, it remains to add a description of its density and current state in terms of the parameters that evaluate the study and the extensibility to other city sizes.

2.- Since qualitative and quantitative data are handled, the types of studies and analysis by stages must be more precisely described.

3.- The methodology describes the six stages in which the study was developed, but it needs to clearly explain how to assess the impact on health.

4.- There needs to be a clear description of the results according to the stages proposed in the methodology.

5.- It is concluded that the other expansion project of the A35 will not improve local mobility neither consider the effects of air or others negative parts of the project. However, according to the study, it is not mentioned what actions could be implemented or analyzed to consider a viable project in its negative points.

Author Response

Dear Reviewer 3, many thanks for your positive and encouraging review of our work.

As the Guest Editor has suggested, we have corrected our text according to his suggestions, which bring together the observations of all 5 reviewers. I hope this is satisfactory for you. Thank you once again for your help in improving our manuscript.

Very best regards,

The Authors

Reviewer 4 Report (Previous Reviewer 4)

Overall, a significantly improved paper from the last submission. There are still some minor issues that should be worked out. See comments below.

The introduction is still clunky. It starts off hyper-specific with the case of the A35 highway and the ring road and then goes into a somewhat general overview of HIA, which is more suited to the literature section. The part of the introduction I want earlier is the purpose of the paper. I think this in general could use some work since you state the purpose and then outline the rest of the paper all in the same paragraph.

Concision --> conciseness

You do not need to tell us how you did your literature review (lines 116-121). Also, I have a sense that HIA are more typically used in professional practice and not in academic research... so why not include reports and such of HIA. Overall, the literature section is improved, but still needs work. It should provide a brief overview of what HIA is. Simply saying, as you do, that it is explained else where, is not sufficient. Since you only include studies that include all four steps, explain what those four steps are. This is part of the background and literature. Explain in what instances HIA is traditionally used and then talk about how it has been applied in transport planning and assessment. The literature and background should discuss the health impacts of transport and the state of knowledge on this. It needs to help you make the argument that HIA is a useful tool to advance assessment of health impacts of transport infrastructure and you simply have not done this.

You state on line 159 that you are surprised the HIAs dealt with social factors and not environmental ones. This is not at all surprising. The things you list under environmental  factors are included in environmental impact assessments, not HIA. Therefore, your review might also benefit from discussion the differences and benefits of HIA over EIA. You also in this same paragraph say that the assessment of social aspects is superficial. Expand on this. You conclude that HIA is not being done on many new road projects, but I would guarantee if you looked at a broad sample of EIAs, then you would likely find that they actually do look at many of the factors you are dealing with. This is particularly true in many U.S. states where EIAs for major infrastructure projects are required.

Table 1 is a great addition. I think it could also be informative to see how the HIA impacted the development of the roadway. This could easily be added in a 5th column.

The first part of the methods and materials should be in the background section.

The rest of the methods section outlining the process is fine.

A major red flag. You don't actually tell us that you are analyzing 6 environmental health determinants until page 7. Why is this not something you highlight earlier in the paper? In the introduction perhaps. You also need to define these in the methods section. What exactly are you looking at for each one? And why? From lines 215-219 they seem somewhat arbitrary.

Results:

Noise: I think a major shortcoming here is not comparing the increase in noise on the new road with potential decreases in noise on the A35 through the center of the city. Of course a new highway will increase noise. You don't need any study to know that. But what is perhaps more important here is overall city-wide exposure to noise. It is actually very likely that is congestion on the A35 decreases, then speeds will increase, and there may be more noise here too. Unless a significant amount of traffic is diverted. This should at least be mentioned.

Road safety. Again here, if there is less congestion, the speed of traffic is likely to be higher on both the original A35 and the ring road. Therefore it is very likely road deaths would increase. Also, a 20km speed reduction on a new highway is not likely realistic. And assuming the design enables high speeds, many people would likely go over the speed limit anyway without very strict enforcement.

Development. I feel like there is something missing after paragraph on lines 354-357? Some additional actual quantitative results?

Living Environment: what are the quantitative health impacts? This section reads more like methods than results.

You need to be more clear about how and why this HIA what done. It seems the local authority commissioned the authors somehow to develop a HIA? This needs to be much more clearly discussed in the introduction.

Overall, the results do not actually present anything besides very broad general statements. To me, this does not meet the requirement for scientific publication.

On line 409 you state the research team collected new data to do the HIA. After reading the results section, I have no idea what this new data was that you are referring to.

Transdisciplinarity is great. But this should be introduced earlier in the paper if it was central to your methods. It is only mentioned a couple times before this rather large section.

Conclusion. In practice, I agree with everything in your conclusion. The problem is, this makes much of the paper read like something that was done simply to justify making an argument that the ring road project should not be built. I agree... it shouldn't be. But the research presented in the paper, does not really make this argument. If you want to draw on critiques of the project from residents, etc. this should be included somewhere in the paper. Perhaps a 'perceived quality of life' metric in the HIA.

Author Response

Dear Reviewer 4, many thanks for your positive and encouraging review of our work. We can see that you have read our new submission very carefully and we appreciate the time and effort that you have put into this new revision exercise.

As the Guest Editor has suggested, we have corrected our text according to his suggestions, which bring together the observations of all 5 reviewers. I hope this is satisfactory for you. In particular, we have added an introductory paragraph in order to avoid the "hyper-specific" entry into the article which might have been a problem for readers not acquainted with the topic and/or area. We have also increased and improved the references to transdisciplinarity.

Thank you once again for your help in improving our manuscript.

Very best regards,

The Authors

Reviewer 5 Report (Previous Reviewer 6)

I have no further comments.

Author Response

Dear Reviewer 5, many thanks for your words of encouragement, much appreciated.

As the Guest Editor has suggested, we have corrected our text according to his suggestions, which bring together the observations of all 5 reviewers.

Very best regards,

The Authors

Round 2

Reviewer 3 Report (Previous Reviewer 5)

The authors have addressed all my concerns, the article can be accepted in the present form.

Reviewer 4 Report (Previous Reviewer 4)

Revisions significantly improve the paper. Accept.

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

This article describes the screening, scoping, evaluation, and recommendation processes of a health impact assessment on a new 24-kilometer 18 highway that skirts the Strasbourg conurbation in France. This study discovered that because the new infrastructure passed through agricultural terrain, it had less of an impact on people's health in terms of noise or air pollution.

However, due to a lack of novelty and significance, this paper is not suitable for journal publication. The following reasons led to the rejection of this manuscript:

1. The goal of the study is not stated in the manuscript.

2.The importance of the study and its contributions to knowledge and policy were not well discussed.

3. The methodology and materials utilized in this study are not addressed in detail.

4. Implications for the results, limits and future study are not explored in the conclusion.

Reviewer 2 Report

Dear Author,

Congratulations on your research. There are some remarks that you could include to improve the quality of your paper:

- line 79 - 80 - 'Nevertheless, several studies and reviews have shown (...)' - it would be better to list exemplary studies and revies in which the subject has been investigated;

- line 95 -  instead of 'see Figure 1' write just '(Fig.1)';

- Fig. 1 - the legend needs to be moved to the left, as it is cut; the font used to sign the names of the cities should be higher;

- Fig. 1 - in the caption under the picture there is a note 'The new ring road (in grey)'; change the description as the whole map is in grey;

 - within the chapter 'Introduction' there should be a new chapter separated - 'Study area' in which some details concerning the research area should be indicated;

- the 'Discussion' section is too short; you should refer to international literature on the subject; there are several issues mentioned in the text that are worth expanded; you could, among others, refer to papers concerning analyses of accessibility of selected services in selected countries, including the access to health care services (for example: 'Geospatial tools in the analyses of land use in the perspective of the accessibility of selected educational services in Poland', 'Mapping accessibility to generic services in Europe: a market-potential based approach', 'Increasing the sophistication of access measurement in a rural healthcare study', etc.; try to cite them; 

- Have you considered verification of the perception concerning modeling? - there is a paper related to the topic - Verification of the Perception of the Local Community concerning Air Quality Using ADMS-Roads Modeling - the purpose of the article was an attempt at a spatial (inner) diversification of a city in terms of air quality, using a study of perception and semantic differentials (SD); Verification of the survey was carried out using the ADMS-Roads (Atmospheric Dispersion Modeling System) software for modeling pollution levels and GIS software, using data on road traffic;

- the 'References' chapter should be expanded; please refer to more items of the literature on the subject - enrich the 'Discussion' section; I would also recommend adding ' Background of the Problem' chapter' in which further citations could also be placed;

- Unify the references (font, year of publication [for example Line 479 - 480], Line 482 - without 'in', Line 483 - without '(', etc.;   

- I would expand the paper; 13 pages don't look impressive (at least 20 would be advisable'.

Please take the remarks into consideration. I wish you further fruitful research.

Best wishes,

Reviewer 

Reviewer 3 Report

The title is rather interesting but the way the methodology was presented made it difficult to understand this study. I think it will be good to clearly state the gap(s) in literature that this study is set to fill. 

In the methods, authors need to briefly and concisely describe the analytical tools used for this study. Did you use primary or secondary data?

Please, kindly revisit the methods section.

Since it is difficult to comprehend the methods the results and discussion may not flow.

In line 401, "In conclusion....., Let all concluding content be found in the conclusion section alone.

In my own view, the conclusion presented (conclusion section) here is rather not emanating directly from the findings of this study

Please, rewrite it. Thank you.

Reviewer 4 Report

Overall, I think this is a pretty good article. It has a clear point and is well written. Below, I have a few specific comments to address, as well as a couple larger comments I mention here. First, I think it may be important to briefly talk about the transportation planning process that was used in planning this new highway. What sorts of analyses were done? What type of public engagement? Etc. I think this is important for setting up the rationale for why a new method - your HIA - is a helpful tool to also use in the planning of new infrastructure.

Second, I think somewhere you need to mention the effects of induced demand and the fact that new road infrastructure typically leads to increases in car use and car ownership. This is counterproductive in an age where cities need to be building climate-friendly infrastructure that supports low-carbon lifestyles.

Third, since you make a point of highlighting differences between high and low/medium income countries, and since you reference the SDGs in the conclusion, it would be good to have a brief discussion on how HIA can be used in broader contexts. For example... how could it be used in low income countries that are developing new roadway infrastructure at a fast pace?

Specific comments.

Abstract: Do not mention methods you intended to use, only talk about what you actually did.

Introduction:

line 56-59: Although the steps of HIA may be described elsewhere, for a reader perhaps unfamiliar, it would be useful to briefly talk about the six steps in a sentence or two each. Or perhaps in a table with a brief description and relevant literature.

line 60-63: It would be good to mention the areas of transport that HIA has been used in, simply to contrast these with road building. I may also differentiate between new roads and new highways. To me, roads implies city streets, whereas, you paper is dealing with a new highway being built.

line 73-76: what is the economic loss you are considering here? briefly describe what this includes. Also, maybe why economic loss in so much higher in wealthy countries and why DALYS are higher in low and middle income countries. Maybe also talk about the relevance of this in your choice of case study in France...

figure 1: use a color other than blue for other municipalities outside Strasbourg. On a quick glance, blue is mistaken for bodies of water...

Methods

line 141: remove reference to a manuscript in preparation.

Results

line 186: is mortality from air quality the only factor you looked at? I would imagine other non-fatal factors like asthma and respiratory disease would be relevant here.

line 217-219: I think you could still estimate here whether there would be a reduction in noise if the A35 highway was turned into a boulevard. There must be examples elsewhere where this has been shown to be the case, since city streets have slower traffic, they do generate less noise. So the decrease here would benefit many more people than the increased exposure from the ring road would affect. I think it is worth exploring this even in a somewhat simple analytical way.

line 229-232: This isn't a comment to address, but I just wanted to comment on the lunacy of a policy where a new ring road would be a toll road when the goal of it would be to alleviate traffic on the existing A35. Why would they not make the new road toll-free and put the toll on the new road? This would better serve the goal, at least as you describe it in the paper.

line 257-273: on what are you basing your results on the impacts on local development?

Reviewer 5 Report

“New roads, public health, and sustainable development: a case study in health impact assessment in Strasbourg, France”

By Guilhem Dardier, Derek P.T.H. Christie, Jean Simos, Anne Roué Le Gall, Nicola L. Cantoreggi, Lorris Tabbone, Yoann Mallet and Françoise Jabot.

In the present manuscript, the authors describe the screening, scoping, assessment, and recommendation steps of a Health Impact Assessment on a new 24-Km highway skirting the conurbation in Strasbourg, France. The main conclusions of the paper point toward documenting environmental health concerns in local populations, and that public consultations may be a used source of data if participatory methods cannot be used.

The paper is organized as follows: firstly, the context, then a detailed description of the experimental setup is exposed. Finally, in the third section, the results are discussed.

Globally, the paper is well constructed. The reviewer is not an English native speaker, but very long sentences mystified me and need complete reformulation. This is the case, especially in the discussion (on lines 338 a 344). The discussion lacks quantitative comparisons and it recommended that it be restructured.

The presentation of the results is confusing, so it is advisable to include graphs and figures. In particular, “impacts on mobility and access to health services, local development, living environment, and global assessment”.

Reviewer 6 Report

An excellent article that describes the methods of placing transport infrastructure from a slightly different angle than we civil engineers usually do. I believe that it would be reasonable to include the impacts of infrastructure on human health in the normal procedures of placing transport infrastructure in space. In my opinion, the publication of the subject article would also contribute to such a decision. The article is readable, comprehensible, well-linked with appropriate references and contains all the elements of an excellent scientific article. I propose publication without further corrections.

Reviewer 7 Report

The authors tackled a very important topic and that is the impact of pollution from transportation on the environment. This is a very difficult topic and at the same time very important in an era of increasing demand for cars and growing number of highways. The areas next to highways are highly polluted. Roads also change the scenic qualities. However, I am concerned about the literature review based on old data from 60 years and early 2000. The infrastructure is completely different then. I think the review should only look at recent data.

Have the authors thought about studying noise levels and creating acoustic maps, for example?

Have the authors thought about measuring land contamination in the vicinity of the highway with the most traffic?

Are there other results than just those presented in the article?

The article is descriptive rather than presenting results as the title suggests.