Geography Reference
In-Depth Information
13.6.1
Health Impact Assessments (HIA)
One way in which local governments have become more engaged in health issues
can be seen in initiatives that focus on the bureaucratic deficiencies of particular de-
partments with respect to health issues. For example, planning decisions have rarely
taken public health issues into account in reviewing and approving development ap-
plications, except in zoning decisions and insuring that such issues as roads, sewers,
water and other utilities are provided. However, towards the end of the twentieth
century new interests emerged that stressed the need to assess the health effects of
public projects on the residents of cities in particular. In part this may be seen as an
extension of the increasing use of Environmental Impact Assessments. These were
designed to investigate the physical and biotic impacts of new developments and
were given statutory approval in many countries as relevant issues to be considered
in decisions made by government planning authorities. Initial support for the Health
Impact Assessment (HIA) concept came from the WHO's concerns over the effec-
tiveness of new sanitation projects in developing countries which led the organiza-
tion to produce a review of procedures for analysing the effects of new development
on health (Birley
1995
). A more general impetus came from the gradual realization
that 'health' cannot be considered in isolation. In some regions it has become a vital
consideration in
all
types of development, especially in terms of changes planned
for the urban environment. This can be seen in Article 152 of the 1997 Amsterdam
E.U Treaty which states:
A high level of human health protection shall be enshrined in the definition and implemen-
tation of all Community policies and activities. (ET 1997)
In Europe the specific concept of the Health Impact Assessment (HIA) emerged
from worries that public development proposals were not being analysed for health
impacts (Scott-Samuel
1996
). For example, concerns about noise and other health
impacts over Manchester airport's second runway proposal in the 1990s led to
guidelines for health assessments, Soon after, the U.K. government committed itself
to using HIAs as an important strategy in development reviews as part of the need
to identifying and reducing health inequalities (Scott-Samuel
1998
).
The so-called Gothenburg Consensus that emerged after a meeting of the WHO
in the Swedish city in 1999 attempted to bring some order into the evaluation pro-
cess by identifying key features that were essential in the development of a HIA
(WHO
1999
). In addition to the general desire to maximize health outcomes they
stressed the need for five values: democracy, so that all people can participate and
help formulate policies; equity, to involve people from all walks of life; sustainable
development in the long and short term; the ethical and transparent use of evidence,
which recognizes that qualitative and non-scientific evidence can also be important
in assessing impacts; and a comprehensive approach to health that considers the
physical, mental and social well-being of all sectors of society and their involve-
ment. Many of these values mirror the arguments used by proponents of a Just City
approach to development within cities (Chap. 3) as well as those seeking to create
greener, more sustainable places (Chaps. 4-6). It was also agreed in Gothenburg
