Health impact assessment in Latin American countries: Current practice and prospects

BackgroundWith the objective to avoid and mitigate potential adverse health impacts of projects, programmes and policies, health impact assessment (HIA) offers an opportunity for disease prevention and health promotion. Although HIA has gained importance over the past two decades, it is unclear whether and to what extent HIA practice has been established and institutionalised in Latin America. To address this issue, the current practice and prospects of HIA in Latin America was assessed in the peer-reviewed literature and existing guidelines.MethodologyThe peer-reviewed literature was systematically searched using five electronic databases until February 2016. Studies were included on a set of pre-defined criteria. The search was carried out in English, French, Portuguese and Spanish. Additionally, a search for HIA guidelines used in Latin American countries and territories was performed by means of a Google search and on websites of government departments and institutions that may promote HIA.ResultsThe search yielded 167 hits in the peer-reviewed literature of which 17 articles met inclusion criteria. Only four peer-reviewed articles described prospective HIAs and four featured a discussion of the HIA approach. The remaining nine articles presented health impact evaluations. Most studies were published only recently, after 2012 (88%). Seven HIA guideline documents were identified, two of which were country-specific (i.e. Brazil and Mexico) and the remaining five addressed HIA at the regional level.ConclusionsThis study confirmed the paucity of literature pertaining to HIA implementation, as well as HIA guidelines in Latin America. Mexico, Brazil and Cuba have the longest track record in scientific literature and guidelines on HIA. In order to better understand current barriers and limitations to practice and institutionalisation of HIA in Latin American countries, a broad discussion among policy makers, academic institutions and HIA practitioners is warranted nationally and regionally.     

A new approach to criteria for health risk assessment

Health Impact Assessment (HIA) is a developing component of the overall impact assessment process and as such needs access to procedures that can enable more consistent approaches to the stepwise process that is now generally accepted in both EIA and HIA. The guidelines developed during this project provide a structured process, based on risk assessment procedures which use consequences and likelihood, as a way of ranking risks to adverse health outcomes from activities subjected to HIA or HIA as part of EIA.The aim is to assess the potential for both acute and chronic health outcomes. The consequences component also identifies a series of consequences for the health care system, depicted as expressions of financial expenditure and the capacity of the health system.These more specific health risk assessment characteristics should provide for a broader consideration of health consequences and a more consistent estimation of the adverse health risks of a proposed development at both the scoping and risk assessment stages of the HIA process.     

Equity-focused health impact assessment: A tool to assist policy makers in addressing health inequalities

In Australasia (Australia and New Zealand) the use of health impact assessment (HIA) as a tool for improved policy development is comparatively new. The public health workforce do not routinely assess the potential health and equity impacts of proposed policies or programs. The Australasian Collaboration for Health Equity Impact Assessment was funded to develop a strategic framework for equity-focused HIA (EFHIA) with the intent of strengthening the ways in which equity is addressed in each step of HIA. The collaboration developed a draft framework for EFHIA that mirrored, but modified the commonly accepted steps of HIA; tested the draft framework in six different health service delivery settings; analysed the feedback about application of the draft EFHIA framework and modified it accordingly. The strategic framework shows promise in providing a systematic process for identifying potential differential health impacts and assessing the extent to which these are avoidable and unfair. This paper presents the EFHIA framework and discusses some of the issues that arose in the case study sites undertaking equity-focused HIA.     

The health impacts of transformative infrastructure change: Process matters as much as outcomes

BackgroundMajor infrastructure development is often transformative for society, including its health. In this realm, there is a growing trend to view airports as drivers for health. By linking airport, urban and health planning, airports can become settings for health. Engaging stakeholders and those affected by such major change in health assessments is essential. This paper demonstrates that health and health equity impacts of major infrastructure developments such as airports extend to the planning processes for these developments; it argues that building a Healthy Airport requires greater consideration of how communities are engaged in these processes.MethodsWe carried out a Health Impact Assessment of community engagement practices for the planning processes of a new greenfield airport in Australia. The standard step-wise process for completing an HIA was followed.Results151 stakeholders participated in the study. Overall, participants were dissatisfied with community engagement for the proposed airport. While there were some unanticipated positive community level impacts resulting from the engagement process (community members becoming involved in community activism), by and large community members identified mostly negative impacts including anxiety, disempowerment, poor social connection, lack of trust and aggravation of health inequities.ConclusionPotentially affected individuals and communities may feel disenfranchised by transformative infrastructure change ‘over their heads’. Missed opportunities to achieve benefits of well-executed community engagement not only lead to feelings of disempowerment and frustration among stakeholders but can potentially negatively impact on individual and community health and well-being. Health impact assessments that effectively assess planning and engagement processes can play a role in mitigating these impacts.     

Health impact assessment in spatial planning in England –types of application and quality of documentation

Health Impact Assessment (HIA) is a decision support approach which is applied in various shapes and forms throughout the world. In England, amongst a range of areas of application, HIA is applied in local (spatial) plan making and project development planning. Whilst various authors have reflected on HIA practice in England, the extent of application and its quality has remained unclear. This paper aims at addressing this gap by reporting on the results of a systematic review of HIA in planning. It is found that between 100 and 200 HIAs are likely being produced each year in England. Whilst most assessments are rapid (desk based), there are also examples of comprehensive and intermediate HIAs, where a participatory procedural approach is followed. An important finding is that those HIAs applied within the context of other assessments (integrated impact assessment -IIA, strategic environmental assessment - SEA/ sustainability appraisal -SA and environmental impact assessment – EIA) tend to be of a higher quality than standalone HIAs, mainly because of the existing comprehensive statutory procedural requirements for these other assessments into which HIA can be integrated.     

Liveability as determinant of health: Testing a new approach for health impact assessment of major infrastructure

Major urban infrastructure projects are intended to alter the built, human ecology for the better. Even when they are not labelled as health projects, arguably they should produce public health benefits that are commensurate with their scale, particularly when they are publicly funded. Health impact assessment (HIA) is an established method of evaluating major infrastructure projects using a determinants of health equity lens. HIA explicitly puts health front and centre to ask, ‘How should the proposed infrastructure project be altered to improve the determinants of health equity?’ There are well-established HIA protocols, but few provide a framework for scoping possible impacts. Given interest in the concept of liveability we introduce an exhaustive, evidence-based framework of 11 liveability domains for HIA. We then test the framework by scoping the impacts of the Upfield Level Crossing Removal (LXR) project in Melbourne, Australia to hypothesise its impacts on health. Scoping this case study suggests that many domains will be affected in complex ways, some positively and some negatively, exemplifying the potential for the framework to detect major infrastructures' pervasive impacts on determinants of health. The paper includes a plan to validate the liveability framework with empirical research in the HIA assessment stage. The paper concludes with a discussion of the contribution and usefulness of the liveability domains as a framework for structuring HIA and for building its profile, thus advancing the discipline, and helping to ensure that all major infrastructures constitute a prudent investment in public health.     

Stakeholder participation in health impact assessment: A multicultural approach

The literature on impact assessment (HIA) registers the importance of stakeholder participation in the assessment process, but still lacks a model for engaging stakeholders of diverse ethnic, professional and sectorial backgrounds. This paper suggests that the multicultural approach can contribute to HIA through a revision of the generic 5-step HIA model, and its implementation in a metropolitan plan in Southern Israel. The health issue scoped by the stakeholders in the HIA is related to land uses in the vicinity of the national hazardous industry and hazardous waste site. The stakeholders were representatives of the diverse populations at stake, including rural Bedouins and Jewish city dwellers, as well as representatives from the public sector, private sector, non-governmental organizations and academia. The case study revealed that a multicultural stakeholder participation process helps to uncover health issues known to the community which were not addressed in the original plan, and provides local knowledge regarding health conditions that is especially valuable when scientific data is uncertain or absent. It enables diverse stakeholders to prioritize the health issues that will be assessed. The case study also reveals ways in which the model needs revisions and improvements such as in recruitment of diverse participants. This paper presents a multicultural model of HIA and discusses some of the challenges that are faced when HIA is implemented in the context of current decision-making culture.     

Assessing the performance of SIA in the EIA context: A case study of South Africa

This article, a theoretical perspective based on a literature study, is a critical evaluation of SIA as part of the EIA process in South Africa against the background of international guidelines and best practices. It includes sections on the historical background of the development of SIA in South Africa, the legal status and requirements of SIA in the country, and a critical evaluation of SIA regulation in South Africa. The conclusion reached in the article is that the persistent problems of SIA practice, experienced in other parts of the world, are also evident in South Africa. Apart from institutional, financial and professional constraints, there are also serious problems associated with approach and methods. This conclusion confirms the findings of empirical studies that SIA in South Africa is neglected, that the practice of SIA in South Africa is not yet on a sound footing, and that it does not receive the professional attention it deserves in a country beset by enormous social challenges. To conclude the article recommendations are made to improve the level of SIA practice in South Africa, and the possible significance of this national case study for international practice is indicated.     

Evaluating the impact of HIA on urban reconstruction decision-making. Who manages whose risks?

Practitioners and academic researchers increasingly look to evaluation of health impact assessment (HIA) to improve its practice, its efficiency and its legitimacy. Evaluation is also used to account to policy-makers, who express doubts that the benefits of HIA justify its costs. Until recently evaluation of HIA focused on instrument design and procedures but now the focus needs to shift to analysis of the interaction of HIA and decision-making. Multiple case studies have been applied to identify the conditions in which HIA produces the desired benefits. These studies used analytical concepts derived from the literature on evaluation, knowledge utilization, science of sociology and knowledge management.This paper describes a case study in which the strategic motives of the decision-makers affected the impact of an HIA. This HIA comprised of a quantitative environmental model ‘City & Environment’ that was used to assess environmental health impacts of an urban reconstruction plan in a Dutch city. The evaluation of the HIA shows that the decision to follow the recommendations of the HIA was part of a damage control strategy. The more HIA goals deviate from the policy problem and the less HIA is embedded in institutional procedures, then the more HIA impact will be subject to strategic decision-making behaviour. Appropriate cognitive and social strategies are needed to avoid ‘negative learning’ in those the HIA seeks to influence.     

Four conceptual issues to consider in integrating social and environmental factors in risk and impact assessments

In the last twenty years, both the increase in academic production and the expansion of professional involvement in Environmental Impact Assessment (EIA) and Social Impact Assessment (SIA) have evidenced growing scientific and business interest in risk and impact analysis. However, this growth has not brought with it parallel progress in addressing the main shortcomings of EIA/SIA, i.e. insufficient integration of environmental and social factors into development project analyses and, in cases where the social aspects are considered, technical-methodological failings in their analysis and assessment. It is clear that these weaknesses carry with them substantial threats to the sustainability (social, environmental and economic) of projects which impact on the environment, and consequently to the local contexts where they are carried out and to the delicate balance of the global ecosystem. This paper argues that, in a sociological context of complexity and dynamism, four conceptual elements should underpin approaches to socio-environmental risk and impact assessment in development projects: a theoretical base in actor–network theory; an ethical grounding in values which are internationally recognized (though not always fulfilled in practice); a (new) epistemological-scientific base; and a methodological foundation in social participation.     

Health impact assessment: A comparison of 45 local,national, and international guidelines

This article provides a comparison of health impact assessment (HIA) guidelines from around the world and for multiple geographic scales. We identify commonalities and differences within HIA guides to discuss the plausibility of consensus guidelines and to inform guideline development. The practice of HIA has grown over the last two decades with a concurrent growth of HIA guides. This study expands on earlier review work and includes guides published since 2007 (Mindell, Boltong and Forde, 2008). From April 2010 to October 2011, 45 HIA guides were identified through an internet search and review of previous research. Common characteristics, key features, and the HIA process were analyzed. The 45 documents recommended similar but not identical processes for conducting HIAs. These analyses suggest that guidelines for HIAs are similar in many areas of the world and that new HIA practitioners can use these findings to inform their approach. Further discussion is needed to determine if the approaches established in these guidelines are followed and if one set of common guidelines could be written for use in numerous countries and regions.     

The role of Health Impact Assessment in the setting of air quality standards: An Australian perspective

The approaches used for setting or reviewing air quality standards vary from country to country. The purpose of this research was to consider the potential to improve decision-making through integration of HIA into the processes to review and set air quality standards used in Australia.To assess the value of HIA in this policy process, its strengths and weaknesses were evaluated aligned with review of international processes for setting air quality standards.Air quality standard setting programmes elsewhere have either used HIA or have amalgamated and incorporated factors normally found within HIA frameworks. They clearly demonstrate the value of a formalised HIA process for setting air quality standards in Australia.The following elements should be taken into consideration when using HIA in standard setting. (a) The adequacy of a mainly technical approach in current standard setting procedures to consider social determinants of health. (b) The importance of risk assessment criteria and information within the HIA process. The assessment of risk should consider equity, the distribution of variations in air quality in different locations and the potential impacts on health. (c) The uncertainties in extrapolating evidence from one population to another or to subpopulations, especially the more vulnerable, due to differing environmental factors and population variables. (d) The significance of communication with all potential stakeholders on issues associated with the management of air quality.In Australia there is also an opportunity for HIA to be used in conjunction with the NEPM to develop local air quality standard measures. The outcomes of this research indicated that the use of HIA for air quality standard setting at the national and local levels would prove advantageous.     

Adapting social impact assessment to address a project's human rights impacts and risks

We address the weaknesses inherent in the social risk assessments undertaken for business, especially in the extractive industries. In contrast to the conventional approach that considers consequence to the company rather than to impacted communities, conformance with the United Nations Guiding Principles on Business and Human Rights requires that consequence to affected communities has precedence. In order for social risks to be properly assessed, we consider that: companies need to know and understand the human rights impacts of their activities; contemporary approaches to project impact and risk assessment need to be adapted to consider human rights; and environmental impact assessment (EIA) and social impact assessment (SIA) methods need to be adapted to give greater attention to impacts on human rights. Using an example from the mining, oil and gas sector, we provide a method that differentiates social risks from business risks, and we position impact assessment as an instrument that actively facilitates the improved identification, analysis and management of social risks. Practical adaptations to SIA activities and risk assessment processes are provided. Taking human rights impacts into account and using the dimensions of gravity, extent, vulnerability and remediability, we nominate criteria to assess the significance of negative social impacts.     

Challenges in meeting international standards in undertaking social impact assessment in Russia

Implementing good practice social impact assessment (SIA) that meets international standards in countries in transition is problematic. We reflect on the challenges faced when undertaking SIA in the Russian Federation. These challenges restrict meaningful SIA processes from being undertaken and limit public participation and the effective community engagement of project-affected local people. Based on the self-reflexive professional experience of two Russian-based social practitioners, and their discursive interactions with two leading academics in environmental and social impact assessment, as well as on in-depth interviews with prominent Russian and international experts, we identified the key challenges that prevent effective SIA from being implemented in Russia: a lack of understanding of the international standards; discrepancy in the determination of the social area of influence between the national requirements and international standards; difficulties in combining national and international impact assessment processes; and a tendency by companies to restrict stakeholder engagement to the minimum. We hope that by having an awareness of these limitations, improvements to SIA practice in Russia and elsewhere will be made.     

Evaluating the use of Social Impact Assessment in the context of agricultural development projects in Iran

The utilisation of Social Impact Assessment (SIA) in Iran is analysed in terms of its policy context and its application in practice. Five case studies where SIA was employed in conjunction with Environmental Impact Assessments (EIA) for agricultural development projects are evaluated. In addition, the performance of the policy context is assessed. This research revealed that there are legal and institutional constraints to the effective functioning of SIA in Iran, and that there are deficiencies in the operating guidelines. There were serious problems associated with the way SIA was undertaken in all five case studies. Recommendations to improve the policy framework for the conduct of SIA are made. The recommendations advocate for a higher profile of SIA within legislation, for social issues to have greater emphasis in official guidelines for the conduct of EIA and SIA, and for a range of measures to increase the professionalism of SIA practice.     

Integrating community perceptions and cultural diversity in social impact assessment in Nigeria

The Environmental Impact Assessment (EIA) Act of 1992 aimed to make the environment a central theme in development in Nigeria. Nevertheless, the extent of engagement with local cultures in the Nigerian EIA process is not statutorily guaranteed. While most EIAs in Nigeria have been for oil and gas projects in the Niger Delta, and have focused strongly on the biophysical environment, socio-economic and cultural aspects have remained marginal. The palpable neglect of community perceptions and cultural diversity in social impact assessment (SIA) in this region prone to conflict has tended to alienate the people in the decision-making process. Thus, despite claims to compliance with regulatory requirements for EIAs, and numerous purported sustainable development initiatives by international oil companies (IOCs), the region continues to face multiple sustainability challenges. This paper situates local perceptions and cultural diversity in participatory development and canvasses the integration of community perceptions and cultural diversity into SIA in the Niger Delta region. It is argued that doing this would be critical to ensuring acceptance and success of development actions within the context of local culture while also contributing to sustainable development policy in the region.     

Social impact assessment and stakeholder engagement in the Russian Federation: Representativeness,deliberativeness and influence

We analyse two approaches to social impact assessment (SIA) – traditional SIA and participatory SIA – in the context of a large project in the Russian Federation. The key difference between these approaches is the level and depth of stakeholder engagement in the impact assessment process and project. Participatory SIA seeks to observe the three principles of participatory democracy: representativeness, deliberativeness and influence. We identify the requirements for stakeholder engagement in the Russian impact assessment process, and analyse implementation practice by reviewing the stakeholder engagement activities undertaken for the South Stream gas pipeline project, according to national requirements and international best practice (e.g. the International Finance Corporation Performance Standards). We conclude that the Russian process reflects traditional SIA. Its main weaknesses are poor stakeholder identification and planning of engagement activities. The Russian SIA/EIA process is not consistent with the principles of representativeness, deliberativeness and influence and does not enable people to adequately participate in or influence decision-making.     

Documentation of cumulative impacts in environmental impact statements

The National Environmental Policy Act (NEPA) of 1969 and the Council on Environmental Quality (CEQ) regulations in the United States require federal agencies to apply an environmental impact assessment (EIA) in decision-making related to their actions. One aspect requires an examination of direct, indirect and cumulative impacts (CIs). Historically, cumulative impact assessment (CIA) has been given limited attention in EIA and resultant environmental impact statements (EISs), not because of its lack of importance, but owing to limitations in methodologies and procedures, including documentation consistency. The objectives of this study were to identify deficiencies in the documentation of CIs and CIA in EISs and to formulate appropriate recommendations (potential solutions) related to such deficiencies. The study involved the systematic review of 33 EISs (11 each from the U.S. Department of Agriculture: Forest Service, the U.S. Army Corps of Engineers, and the U.S. Department of Transportation: Federal Highway Administration). The results indicate that improvements have been made in documentation practices since 1990; however, inconsistencies and inadequacies still exist. Therefore, the following recommendations were developed: (1) CIs should be reported in a separate part of the “Environmental Consequences” section, and they should be addressed for each pertinent environmental resource; (2) a summary of CIs should be included; (3) any CIs considered not significant should be mentioned plus the reason(s) for their non-significance; (4) spatial and temporal boundaries addressed within the CIA process should be defined for pertinent environmental resources; and (5) utilized guidelines and methodologies should be described.     

The needs of nomadic-pastoral land users with respect to EIA theory,methods and effectiveness: What are they and does EIA address them?

The aim of this article is to examine the needs of nomadic-pastoral land users with respect to EIA theory, methods and effectiveness based on literature review by applying Retief (2010)’s framework. The article intends to identify these needs and analyse whether EIA addresses them sufficiently and appropriately. Retief (2010)’s framework defines theory, methods (quality) and effectiveness as three main interrelated themes of environmental assessment. Our review was guided by these three themes and moreover, using nomadic pastoralism as a test case, we attempted to expand this broad framework into a four-step approach that can be used to systematically examine EIA literature. The approach first adopts the Retief (2010)’s framework and secondly, identifies issues of nomadic-pastoral land use which matter the most with respect to Retief (2010)’s themes. The next step selected 156 articles for literature review considering the issues identified previously and the fourth step examined the selected articles using a concept-centric review and a content analysis. Nomadic-pastoral land users need EIA theory to incorporate irrational logic and complex and unpredictable socio-ecological features of nomadic-pastoral land use. Decisions made based on the rational decision-making model in EIA cannot sufficiently incorporate the needs of nomadic-pastoral land use due to uncertainties associated with rational decision-making and different power, values and interests of stakeholders in pasture land resources. Furthermore, the needs of nomadic-pastoral land users with respect to EIA methods are related to impact pathways and dynamic character of land use. EIA methods systematically address impact pathways. However, the current EIA methods primarily focus on static land use, and do not address sufficiently and appropriately dynamic nature of land use. For nomadic-pastoral land users, maintaining land quality in nomadic pastoralism and participation in EIA are the most important issues with respect to effectiveness of EIA. However, empirical data are needed to examine whether these needs are addressed in EIA. Nevertheless, the current frameworks for evaluation of effectiveness of EIA are sufficient for assessment of EIA's capacity for addressing the needs of nomadic-pastoral land users. Further studies should aim at incorporating the nature of socio-ecological interaction and dynamics into EIA theories and developing suitable models on herding mobility and strategy for impact prediction in EIA.     

Rethinking human health impact assessment

Most EIA programs around the world require the consideration of human health impacts. Yet relatively few EIA documents adequately address those impacts. This article examines how, why, and to what extent health impacts are analyzed in environmental impact assessments in the U.S. An empirical study of 42 environmental impact statements found that more than half contained no mention of health impacts. In the others, health impacts were analyzed narrowly, if at all, using risk assessment to quantify the carcinogenic potential of a single substance over a single generation. This analytic focus overlooks other significant morbidity and mortality risks, cumulative and intergenerational effects, and broader determinants of health. This article investigates these problems and provides recommendations to improve human health impact assessment, using strategic environmental assessment, qualitative health data, health outcomes in addition to cancer, and a precautionary approach to risk.