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Appendix A Experiences with Health Impact Assessment To develop a framework and guidance for the practice of health impact as- sessment (HIA) in the United States, the committee felt that it was critical to review the HIA experience of the international community given its use of HIA over the last several decades. The international experience in implementing HIA has involved different institutional arrangements, mechanisms for knowledge transfer, tools, and capacity. On examination of the international experience, the committee identified three main mechanisms for introducing HIA. The first is to incorporate HIA into existing assessment processes—for example, environ- mental impact assessment (EIA) under the National Environmental Policy Act (NEPA)—and thus make human health an explicit consideration in the mecha- nisms for approval of policies, plans, programs, and projects. The second is to require HIA explicitly by law or regulation or in response to defined triggers. The third is to use HIA voluntarily but to provide various degrees of government support and resources. In this appendix, the committee examines how the inter- national community has used those mechanisms and what lessons the global experience offers for one who is considering a framework and guidance for HIA in the United States. This appendix is not a comprehensive review, but it seeks to summarize HIA experience in Canada, Europe, Australia, and Thailand. It also looks at the use of HIA by indigenous people and multilateral organizations. The committee reviews HIA experience in the United States and discusses the relationship be- tween HIA and the process of EIA. The appendix concludes with comments on the use of HIA in the private sector and some important lessons learned from the experience to date that are relevant to the future use of HIA in the United States. The committee notes that this appendix uses the terms health and health impact assessment. To examine the international experience, the committee recognized that it was important to consider the wider policy context and to view HIA as one among many methods by which health is incorporated into decision-making. 130

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131 Appendix A CANADA In the early 1970s, a central government think tank, the Long Range Health Planning Branch, identified the effects of lifestyle and environment on public health and began to consider policy solutions to improve public health (Laframboise 1973; McKay 2000). That activity culminated in a report that identified objectives for the health-care system and for the prevention of health problems and promotion of good health (Lalonde 1974). A combination of re- search and advocacy was introduced to support and validate the notion that pub- lic policies affect determinants of health (Milio 1981; WHO 1986, 1988). Healthy Public Policy Health and environment are under provincial jurisdiction in Canada. Two provinces, British Columbia and Québec, have formalized HIA as a component of policy-making, and they offer different experiences (Banken 2001, 2004; Kwiatkowski 2004; Gagnon et al. 2008). In British Columbia, attention to the health of the population was advanced by a group of government officials who had an interest in health promotion. From 1989 to 1995, structures and policies for HIA were starting to be included in British Columbia’s health-care policy, and it was proposed that HIA of all government projects, programs, and laws be conducted. Guidelines were produced, and a series of workshops were held to raise awareness of and develop capacity for HIA1 (Banken 2004). By 1999, the values underpinning the reform of health care had changed, and resources for HIA were redeployed. The guidelines that required the use of HIA in govern- ment decisions were not changed, but they were no longer seen as mandatory. Banken (2004) concluded that the rise of HIA in that short time had been accel- erated by key persons in the British Columbia Ministry of Health, that it did not benefit from wide ownership, and that it had become closely identified with a particular policy orientation. Banken contended that if other institutions had been more involved in examining the value of and establishing structures for HIA, support for HIA would not have withered as quickly after the policy direc- tion changed and after key persons left the ministry. Québec had a different experience in using HIA as part of healthy public policy. Banken (2001) traced the linking of environment and health to robust public-health input during hearings on the use of pesticides (BAPE 1983). That input led to a memorandum of understanding (MOU) between Québec’s Minis- tries of Health and Environment. A framework was developed to support the memorandum and led to the systematic practice of integrating health and the environment into projects and policies (Banken 2001, 2004). In the 1990s, pol- 1 The committee is not aware of any examples of HIA from this period. Therefore, al- though it is documented that HIA was a part of the policy discussion, it is not possible to evaluate how HIA was conducted in British Columbia.

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132 Improving Health in the U.S.: The Role of Health Impact Assessment icy documents recognized the need for intersectoral initiatives to improve health (Government of Québec 1998, 1999) and explicitly recommended the systematic assessment of the impacts of public policies on health. The assessments were to be conducted by the Study Commission for Health and Social Services (Com- mission d’Étude sur les Services de Santé et les Services Sociaux), which ana- lyzes health services. HIA was included in Québec’s 2001 Public Health Act, which requires government ministries and agencies to ensure that legislative provisions do not adversely affect the health of the population. It also requires that the minister of public health be consulted on all policies that could have an important health effect (Section 54, Government of Québec 2001). Figure A-1 shows the number of requests for consultations from other ministries. In 2011, the national public health director and the assistant deputy minister in the Ministry of Health and Social Services (Ministère de la Santé et des Services Sociaux) of Québec stated that there were 434 requests for advice from 2003 to 2011 (Poirier 2011a). Al- though the demands of the legislative calendar influence the number of requests from year to year, the figure indicates a clear upward trend. The trend is ascribed to the Ministry of Health and Social Service’s efforts to develop an understand- ing of Section 54 across the government, improvements in how the ministry processes requests for consultation and provides its advice, and the application of a public-health perspective to a wider array of policies. 120 107 Number of Requests for Consultation 100 80 73 65 62 60 41 41 36 40 20 9 0 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 FIGURE A-1 Number of requests for consultation received by the Québec Ministry of Health and Social Services, 2003-2008. Source: L. Jobin, Ministry of Health and Social Services, Québec, personal communication, 2011.

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133 Appendix A The Québec public-health law is noteworthy because it focuses on the processes by which the government will request assistance on health issues and on how that assistance will be provided by the Ministry of Health (for more in- formation, see NCCHPP 2008). Clearly defining the process has helped to en- sure that government departments request health input when writing policy. The Ministry of Health and Social Services has also worked to heighten awareness and to gain the support of other government ministries and agencies (NCCHPP 2008). Although changes are occurring slowly, channels of communication be- yond government departments covered by the law are being opened, and this has led to the integration of the health sector (and health consideration) into the po- litical-administrative process. Furthermore, the government’s knowledge devel- opment and transfer strategy to support the implementation of the law has strengthened research capacity on healthy public policy in academic sectors and in the Institut National de Santé Publique du Québec (L. St-Pierre, National Col- laborating Centre for Public Policy and Health, Québec, personal communica- tion, 2010). Some issues, however, still need to be resolved. Many government minis- tries do not comply with the law, and most requests to the Ministry of Health come from the Executive Committee, which is well versed in the importance of health effects. In addition, the process does not specify a particular method of conducting a health assessment (L. St-Pierre, National Collaborating Centre for Public Policy and Health, Québec, personal communication, 2010). Further ef- forts clearly are required to foster responsibility for health in some parts of gov- ernment, such as economics and finance. The next steps envisaged include feed- back mechanisms to monitor and evaluate how support is offered and taken and how recommendations are implemented. Continued support for changes in prac- tice is needed through high-quality and strategic evaluations that facilitate ac- tions early in the decision-making process, knowledge transfer, and strategic monitoring (Héroux de Sève et al. 2008; Poirier 2011b). Examining Human Health in Environmental Impact Assessment In 1995, the Federal-Provincial-Territorial Committee on Environmental and Occupational Health convened a task force in response to reviews that dem- onstrated that health aspects were inconsistently or only partially addressed in EIA. The task force was asked to develop a definition of HIA that would be ac- ceptable to all jurisdictions, a public-health framework appropriate to HIA, guidance and training material for HIA, and strategies for increasing awareness about HIA, EIA, and the relationship between human health and the environ- ment (Kwiatkowski 2004). The task force concluded that HIA should be pro- moted within the existing legislated federal or provincial EIA processes; that HIA was not the responsibility of any one government department or agency in that many factors—including environmental, social, economic, and occupational

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134 Improving Health in the U.S.: The Role of Health Impact Assessment ones—affect public health; and that HIA should use a multidisciplinary ap- proach informed by the many determinants of health rather than a narrow defini- tion of health (Kwiatkowski 2004). A review by Davies and Sadler (1997) was influential in establishing a case for examining human health in environmental assessment in Canada. A major output of the initiatives was the Canadian Handbook on Health Impact Assessment, a comprehensive resource that was first published in 1998 and has since been updated (Health Canada 2004a,b,c,d). About 6,000 projects a year undergo EIA under the Canadian Environ- mental Assessment Act, so it is no small feat to ensure that potential health ef- fects are considered for each project (Kwiatkowski and Ooi 2003). EIAs are characterized as screening, comprehensive study, or public-panel review. As implied by its name, screening is less intensive than the other types and accounts for over 95% of EIAs conducted (Kwiatkowski and Ooi 2003). What is the current experience of incorporating HIA into EIA? Social ef- fects are considered in EIA in Canada; this makes it somewhat easier to include a wide array of health determinants in assessments (M. Orenstein and M. Lee, Habitat Health Impact Consulting, personal communication, 2011). Noble and Bronson (2005, 2006) reviewed three mining case studies and conducted a sur- vey of environmental-assessment practitioners, health practitioners, administra- tors, and special-interest groups in northern Canada. They found that health has typically been considered only in the early stages of the environmental- assessment process and that only physical health effects associated with project- related environmental damage have generally been considered. As a rule, health and social determinants have not been considered or have been considered only in the context of factors—such as employment opportunities and worker health and safety—that the project sponsor directly controls. The authors acknowl- edged, however, that the scope of attention to health in EIA has more recently been expanded to reflect a wider array of health determinants that includes a group’s culture and its traditional land use. They concluded that there is a need to adopt measures to mitigate adverse effects and optimize beneficial effects that the community is sensitive to, to ensure that the measures are effective, and to monitor and evaluate the effects after project approval (Noble and Bronson 2005, 2006). The committee notes that the somewhat bleak assessment by the authors is based on a small sample and may be unduly harsh. Although systematic collaboration between public health and the envi- ronment sector can be improved, research indicates that health is being consid- ered to some extent in EIA. Overall, Canada has some of the most extensive and successful experiences of including HIA in EIA and of analyzing and improving HIA practice. This work is not always labeled as HIA, but health is increasingly a component of an integrated approach to environmental assessment (Orenstein et al. 2010; M. Orenstein and M. Lee, Habitat Health Impact Consulting, per- sonal communication, 2011).

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135 Appendix A THE EUROPEAN UNION HIA has been practiced in the European Union (EU) since the 1980s. Dur- ing the 1990s, there were developments in HIA methodology and practice in Germany, the Netherlands, Sweden, and the United Kingdom. In the late 1990s, the WHO European Centre for Health Policy played a key strategic role in European HIA policy development, and its 1999 Gothenburg consensus confer- ence produced the first universally accepted definition of HIA. Although requirements and practice have differed, there are examples of health assessment in the environmental-assessment framework,2 in stand-alone HIAs, and in all types of policies—from local policies to policies covering the EU. Explicit policies for HIA exist, but its practice is often advanced through the actions of committed individuals. Research grants from the EU play an im- portant role in enabling research and in developing techniques and capacity for HIA. The grants have funded multicenter studies that involve universities, the public sector, and occasionally private-sector bodies across the EU (see, for example, Abrahams et al. 2004; Hilding-Rydevik et al. 2005; WHO 2005a,b,c,d; Wismar et al. 2007; Gulis et al. 2008; HEIMTSA consortium 2010; and INTARESE consortium 2010). In the EU, HIA is recognized as a process that sits within the broader sphere of public-health policy and sustainable development. It is one of the ways in which partnerships are developed between municipalities and health authori- ties and is increasingly used as a mechanism by which land-use or spatial plan- ning can work in partnership with public health. Although skills and capacity for HIA are not widespread, there are isolated examples of universities’ incorporat- ing HIA as part of a curriculum to train planners and public-health professionals. In a study of HIA across Europe, Wismar et al. (2007) showed that HIA has been used in various countries, at various levels, and in various sectors. They noted that participation and equity considerations have played substantial roles in the practice of HIA and concluded that despite the reported variations, HIA can be used prospectively, cover all stages of the policy process, and use differ- ent types of approaches. The following sections provide background on the EU and on the inte- grated assessment framework used for EU policy. Approaches for integrating health into environmental assessment across Europe are discussed next,3 and then other approaches that have been put into place across Europe to enable HIA to be conducted are reviewed. 2 Regarding environmental assessment in the EU, human-health measures are included in directives and legislation that regulate the effects of development on the environment. 3 This summary does not examine legislation for equality and human rights in the EU, which also leads to policy assessment and can incorporate health issues.

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136 Improving Health in the U.S.: The Role of Health Impact Assessment Incorporation of Health into Policies, Plans, Programs, and Projects in the European Union In 2010, the EU had 27 member states and four applicants for membership (see Box A-1). Policies and laws that apply throughout the EU are produced mainly by the joint work of three institutions: the European Commission, the European Parliament, and the Council of the European Union. The European Commission, which proposes new laws and then works with member states to implement them, is divided into departments and services (EC 2011a). Public health falls under the Directorate-General for Health and Consumers, and envi- ronmental stewardship falls under the Directorate-General for the Environment. Public health is a relatively new policy topic at the EU level, and member states continue to hold the main responsibility for national health policy.4 Actions at the EU level complement actions at the national level, for example, by address- ing major health threats and issues that have a cross-border or international im- pact, such as pandemics and bioterrorism; by addressing health threats related to the free movement of goods, services, and people; by promoting healthier life- styles; and by supporting the work of national authorities. It is recognized that public health is not solely an issue for health policy. For example, in 1997, the Amsterdam Treaty of the EU required that all European Community policies protect health. Thus, the “health in all policies” approach is required for internal and external policies, and support is given for the use of impact assessment and other tools that evaluate health (CEC 2007). The European Commission assesses initiatives for their potential eco- nomic, social, and environmental consequences before it proposes them (EC 2011b). Health is considered in that process as one of several topics in an inte- grated impact assessment framework. The guidelines for the framework were updated in 2009 to review public health and safety and to enhance the considera- tion of social impacts, including access to and effects on social protection, health, and educational systems (EC 2009a). Specific attention has been given to distributional effects and effects on poverty and social inclusion in the EU and developing countries (EC 2009b). Reviews show a small increase in the number of mentions of the word health in the European Commission’s impact assess- ment reports; thus, although progress is slow, consideration of health in the framework is increasing (Ståhl 2010). However, the framework for impact 4 Before 1992, health was addressed in the context of health and safety in the work- place and as an issue of consumer safety. The 1992 Maastricht Treaty (EC 1992) was the first treaty to feature an article on public health and to explain the added value of Europe- wide approaches to common challenges in health while confirming that health care re- mains the mandate of national authorities. Later reform treaties (EC 1997, 2007) en- hanced the role of the EU in supporting member states in cooperating and sharing good practice, such as in health-technology assessment, and in tackling cross-border health threats and disease prevention.

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137 Appendix A BOX A-1 European Union Members and When They Joined 1952 – Belgium, France, Germany, Italy, Luxembourg, and Netherlands 1973 – Denmark, Ireland, and United Kingdom 1981 – Greece 1986 – Portugal and Spain 1995 – Austria, Finland, and Sweden 2004 – Cyprus, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, Slovakia, and Slovenia 2007 – Bulgaria and Romania Candidate Countries: Croatia, Turkey, the Former Yugoslav Republic of Macedonia, and Iceland. Source: EU 2011a,b. assessment has been criticized for failing to improve the consideration of public health, for example, in focusing on specific health services rather than the wider health of the general public (Ståhl 2010), in placing a low priority on health so that it is not seen as a factor that can differentiate between policy options (Ståhl 2010), in focusing on the effects on the economy or the business environment, and in being open to undue influence from corporate interests (Smith et al. 2010a,b). Environmental-Assessment Directives As noted, one of the roles of the Directorate-General for the Environment is to ensure that member states comply with the requirements of the environ- mental directives. Environmental assessment is a key mechanism for evaluating individual projects identified by the EIA directive (Council of the European Union 1985) or public plans or programs identified by the strategic environ- mental assessment (SEA) directive (EP/Council 2001). “The common principle of both directives is to ensure that plans, programs, and projects that are likely to have significant effects on the environment are made subject to an environ- mental assessment prior to their approval or authorization” (EC 2011c). Consul- tation with the public is a key feature of environmental-assessment procedures. Member states are free to supplement the assessment processes, and they must incorporate them into their national consent regimes (that is, the frame- work by which projects are given permission). For that reason, there is some variation in processes between member states. The Directorate-General for the Environment ensures that each member state implements the EIA and SEA directives, and the European Court of Justice is the final arbiter if assessments are disputed. As both directives are procedural, the courts tend to be concerned

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138 Improving Health in the U.S.: The Role of Health Impact Assessment with how the assessments have been conducted rather than with their accuracy. Issues of quality are typically left to the organizations overseeing the consenting process, although that can be problematic; for example, health authorities are not always asked to comment on the health components of environmental assess- ments. Environmental Impact Assessment The EIA directive applies to public and private projects (Council of the European Union 1985).5 Annex I of the directive stipulates projects for which it is mandatory to conduct an EIA, such as railways, roads, waste-disposal installa- tion, and waste-water treatment plants. Member states have discretion over whether to conduct an EIA on projects listed in Annex II, such as some types of agricultural or extractive-industry projects, urban-development projects, and flood-relief projects. Although the rationale for the EIA directive states that “the effects of a project on the environment must be assessed in order to take account of con- cerns to protect human health” (Council of the European Union 1985), human health is not explicitly included in the list of direct and indirect effects of a pro- ject that must be identified, described, and assessed.6 Although environmental assessment considers health protection (for example, calculations of safe expo- sures are included in the derivation of environmental limits for air emissions and water quality), EIAs do not look in detail at the populations likely to be exposed, and compliance with the environmental limits does not mean that there will be no health effects (even small increases in air emissions can have effects on health). National governments have interpreted the EIA directive differently, and their interpretations determine the extent to which health is explicitly considered in EIA (Bond 2004). For example, the English ministry responsible for planning has resisted including health explicitly in EIA; in contrast, Germany has sought to address health in EIA and passed a resolution in 1992 on HIA in the context of EIA (Fehr et al. 2004). The boundaries are set by bureaucrats in government ministries whose interests often lie in avoiding placement of extra duties on their minister or on businesses. Frequently, the approach taken is to meet legal com- pliance with minimum expense, and this can result in poor coverage of health. A review of 39 environmental impact statements in the United Kingdom found that 72% did not list human health in the table of contents, 49% provided no analysis of possible human-health effects, and 67% did not include sufficient data to es- 5 The EIA directive has been amended three times (EP/Council 2001, 2003, 2009) to bring it into line with United Nations Economic Commission for Europe Conventions (UNECE 1991, 1998) and to update the list of projects that come under the EIA directive to include those related to transport, capture, and storage of carbon dioxide. 6 The effects include those on human beings, fauna and flora, soil, water, air, climate and landscape, interaction between them, material assets, and cultural heritage.

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139 Appendix A timate the number of people potentially affected by the project or activity being considered (British Medical Association 1998 cited in Bond 2004). A study of the application of the EIA directive concluded that when possi- ble human health effects of a project should be assessed in an EIA rather than by a separate HIA (Hilding-Rydevik et al. 2005). The authors acknowledged that best practice for including health in EIA remains undefined and depends on a number of factors, such as how health is defined (that is, whether it is based on environmental impacts or on a wider array of human health determinants) (Hilding-Rydevik et al. 2005). In a 2009 survey of the application of the EIA directive, all new member states reported that human health aspects are assessed as part of the EIA reports (COWI 2009). Common elements include the identification of human health effects during the scoping stage of EIA, consultations with health authorities or experts in the field on human health, and assessment of human health effects as a part of the environmental documentation submitted by a developer. Few new member states, however, have produced specific guidance documents for those activities (COWI 2009). Most new member states that were surveyed define health in environmental terms and involve public-health authorities mainly on environmental-health matters. For example, in Hungary, human health issues are examined in the EIA procedures for transport projects (focusing on noise), transmission lines (focusing on nonionizing radiation), hazardous-waste man- agement facilities (focusing on complex effects on environmental health), and strip mines and cement factories (focusing on air pollution). Malta is the only member state that mentions well-being and states that, when relevant, health and well-being are studied with reference to socioeconomic impacts (COWI 2009). Strategic Environmental Assessment The SEA directive (EP/Council 2001) refers to public plans and programs but not to policies. The idea is to identify issues at a strategic level so that they do not arise at a project level; in practice, however, the link between strategic assessment and project assessment has proved problematic. Although SEAs are used to evaluate plans in various sectors, they are conducted primarily for land- use planning (EP/Council 2001).7 If the environmental effects of plans or pro- grams are deemed likely to cross national boundaries, the member state in whose territory the plan or program is being prepared must consult the other member states (EC 2011d). The SEA directive, unlike the EIA directive, explic- itly requires the consideration of “the likely significant effects on the environ- ment, including on issues such as … human health” (EP/Council 2001). The debate on how to include health in SEA is evolving in Europe. 7 SEA is mandatory for plans or programs that are prepared for a prescribed range of sectors and set the framework for granting consent for the future development of projects listed in the EIA directive (EC 2011d).

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140 Improving Health in the U.S.: The Role of Health Impact Assessment The SEA directive requires that numerous aspects be examined, including human health, but it does not provide detailed definitions of those aspects. Thus, health is addressed in SEA practice in various ways and in ways that do not sys- tematically require the input of public health or even formal sign-off from health authorities. In Denmark, health is a formal component in the assessment of spa- tial plans; noise, drinking water, air pollution, recreation and outdoor life, and traffic safety are considered with regard to health (Kørnøv 2009). A review of eight SEAs in England and Germany found that all considered aspects of physi- cal and natural effects (such as noise, emissions, and pollution) on health, and four considered social and behavioral aspects (Fischer 2010). Ensuring that im- portant health effects are satisfactorily identified and considered is challenging, and the SEA directive has not yet led to widespread involvement of public- health experts in the assessment process or in planning. One difficulty is that the health sector tends to be outside the plan-making process, and most HIA experi- ence tends to be at the project level (Cave et al. 2007). In 2010, the SEA protocol on EIA, which has been adopted by at least 35 member countries, will enter into force (UNECE 2003). It goes much further than the SEA directive in referring explicitly throughout to impacts on environ- ment and health, in indicating that all health impacts should be considered (not only those associated with environmental factors), and in indicating that health authorities should be consulted at the different stages of the process. Examples of Advancing Health Impact Assessment Independently of Environmental Impact Assessment and Strategic Environmental Assessment Member countries have taken different approaches to advancing HIA out- side the environmental-assessment process. Since the late 1990s, Sweden has used HIA as a mechanism for addressing the determinants of health in policy- making (Berensson 2004). Although no legislation requires HIA, agencies, counties, and municipalities continue to learn about and use it. Local politicians across Sweden were actively involved in developing the country’s initial guid- ance documents for HIA and recommended that health be an early part of all policy discussions (SFCC 1998). The decision to screen all political proposals to determine which should be further evaluated led to many policies being recom- mended for HIA (Nilunger et al. 2003). Sweden’s Health Policy Act of 2003 based its national objectives on health determinants rather than diseases or health problems and linked achieve- ment of the objectives to a monitoring system and annual evaluations. In 2005- 2008, 11 central agencies and all of Sweden’s county administrative boards were required to implement HIA and were supported by the National Institute of Pub- lic Health in doing so (Knutsson and Linell 2010). Although the requirement has heightened interest in and political support for issues related to public health and particularly HIA, there is no legal requirement for HIA, and there are no specific

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167 Appendix A Dora, C., and F. Racioppi. 2003. Including health in transport policy agendas: The role of health impact assessment analyses and procedures in the European experience. Bull. World Health Organ. 81(6):399-403. Eaton, S., L. St-Pierre, and M.C. Ross. 2009. Influencing Healthy Public Policy with Community Health Impact Assessment, National Collaborating Centre for Healthy Public Policy, Canada. November 2009 [online]. Available: http://www.ncchpp. ca/docs/PATH_Rapport_EN.pdf [accessed June 1, 2011]. EC (European Communities). 1992. Treaty on European Union signed at Maastricht on February 7, 1992. O.J. Eur. Comm. C 191, July 29, 1992 [online]. Available: http:// eur-lex.europa.eu/en/treaties/dat/11992M/htm/11992M.html#0001000001 [access- ed June 1, 2011]. EC (European Communities). 1997. Treaty of Amsterdam amending the Treaty on Euro- pean Union, the Treaties Establishing the European Communities and related acts. O.J. Eur. Comm. C 340, November 10, 1997 [online]. Available: http://eur-lex.| europa.eu/en/treaties/dat/11997M/htm/11997M.html#0145010077 [accessed June 1, 2011]. EC (European Communities). 2007. Treaty of Lisbon amending the Treaty on European Union and the Treaty establishing the European Community. O.J. EU C 306(50), December 17, 2007 [online]. Available: EC (European Commission). 2009a. Commission Impact Assessment Guidelines [on- line]. Available: http://ec.europa.eu/governance/impact/commission_guidelines/co mmission_guidelines_en.htm [accessed June 1, 2011]. EC (European Commission). 2009b. The Main Changes in the 2009 Impact Assessment Guidelines Compared to 2005 Guidelines. Memo from Secretariat General Unit C/2, Better Regulation and Impact Assessment, September 2, 2009 [online]. Available at http://ec.europa.eu/governance/impact/commission_guidelines/docs/re vised_ia_guidelines_memo_en.pdf [accessed June 1, 2011]. EC (European Commission). 2011a. Departments (Directorates-General) and Services. Europa [online]. Available: http://ec.europa.eu/about/ds_en.htm [accessed June 1, 2011]. EC (European Commission). 2011b. Impact Assessment. Europa [online]. Available: http://ec.europa.eu/governance/impact/index_en.htm [accessed June 1, 2011]. EC (European Commission). 2011c. Environmental Assessment. Europa [online]. Available: http://ec.europa.eu/environment/eia/home.htm [accessed June 1, 2011]. EC (European Commission). 2011d. Strategic Environmental Assessment - SEA. Europa [online]. Available: http://ec.europa.eu/environment/eia/sea-legalcontext.htm [ac- cessed June 1, 2011]. Elinder, L.S., L. Joossens, M. Raw, S. Andreasson, and T. Lang. 2003. Public Health Aspects of the EU Common Agricultural Policy. Developments and Recommenda- tions for Change in Four Sectors: Fruit and Vegetables, Dairy, Wine and Tobacco. Swedish National Institute of Public Health [online]. Available: http://www.fhi. se/PageFiles/4464/eu_inlaga.pdf [accessed Feb. 11, 2011]. enHealth (enHealth Council). 2001. Health Impact Assessment Guidelines. Canberra: Commonwealth of Australia. September 2001 [online]. Available: http://www. health.gov.au/internet/main/publishing.nsf/content/35F0DC2C1791C3A2CA256F1 900042D1F/$File/env_impact.pdf [accessed May 5, 2011]. EP/Council (European Parliament and Council of the European Union). 2001. Directive 2001/42/EC of the European Parliament and of the Council of 27 June 2001 on the assessment of the effects of certain plans and programmes on the environment. O.J. Eur. Comm. L 197:30-37.

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168 Improving Health in the U.S.: The Role of Health Impact Assessment EP/Council (European Parliament and the Council of the European Union). 2003. Direc- tive 85/337/EEC on the assessment of the effects of certain public and private pro- jects on the environment, as amended by Directive 97/11/EC and Directive 2003/35/EC. O.J. EU. L 156:17. June 25, 2003. EP/Council (European Parliament and Council of the European Union). 2009. Directive 2009/31/EC of the European Parliament and of the Council of 23 April 2009 on the geological storage of carbon dioxide and amending Council Directive 85/ 337/EEC, European Parliament and Council Directives 2000/60/EC, 2001/80/EC, 2004/35/EC, 2006/12/EC, 2008/1/EC and Regulation (EC) No 1013/2006. O.J. EU L140/141, June 5, 2009 [online]. Available: http://eur-lex.europa.eu/LexUriServ/ LexUriServ.do?uri=OJ:L:2009:140:0114:0135:EN:PDF [accessed June 1, 2011]. EPA (U.S. Environmental Protection Agency). 2009. Red Dog Mine Extension Aqqaluk Project. Final Supplemental Environmental Impact Statement. Prepared for U.S. Environmental Protection Agency, Seattle, WA, by Tetra Tech, Inc., Anchorage, AK. October 2009 [online]. Available: http://www.reddogseis.com/Docs/Final/ Front_Matter.pdf [accessed Nov. 30, 2010]. EPA (U.S. Environmental Protection Agency). 2010. Scoping a Health Impact Assess- ment (HIA for the Ports of Los Angeles and Long Beach. Pacific Southwest Re- gion 9, U.S. Environmental Protection Agency [online]. Available: http://www. epa.gov/region9/nepa/PortsHIA/index.html [accessed Nov. 30, 2010]. EU (European Union). 2009. Building Health Communities. Newsletter No 3, November 2009 [online]. Available: http://urbact.eu/fileadmin/Projects/Building_Healthy_Co mmunities_BHC_/outputs_media/newsletter03_1.pdf [accessed Nov. 30, 2010]. EU (European Union). 2011a. About EU: Countries. Europa [online]. Available: http://europa.eu/about-eu/countries/index_en.htm [accessed June 1, 2011]. EU (European Union). 2011b. The 27 Member Countries of the European Union. Europa [online]. Available: http://europa.eu/about-eu/27-member-countries/index_en.htm [accessed June 1, 2011]. Farhang, L., R. Bhatia, C.C. Scully, J. Corburn, M. Gaydos, and S. Malekafzali. 2008. Creating tools for healthy development: Case study of San Francisco’s Eastern Neighborhoods Community Health Impact Assessment. J. Pub. Health Manag. Pract. 14(3):255-265. Farhang, L., and R. Bhatia. 2007. Eastern Neighborhoods Community Health Impact Assessment, Final Report. San Francisco Department of Public Health. September 2007 [online]. Available: http://www.sfphes.org/ENCHIA.htm [accessed Feb. 4, 2011]. Fehr, R., O. Mekel, and R. Welteke. 2004. HIA: The German perspective. Pp. 253-264 in Health Impact Assessment: Concepts, Theory, Techniques and Applications, J. Kemm, J. Parry, and S. Palmer, eds. Oxford: Oxford University Press. Fischer, T.B. 2010. The consideration of health in SEA Pp. 20-42 in Health and Strategic Environmental Assessment. Background Information and Report of the WHO Consultation Meeting, June 8-9, 2009, Rome, Italy, J. Nowacki, M. Martuzzi, and T.B. Fischer, eds. Denmark: World Health Organization. Gagnon, F., M. Michaud, S. Termblay and V. Turcotte. 2008. Health Impact Assessment and Public Policy Formulation. Québec Library of National Archives, Québec, Canada [online]. Available: http://www.gepps.enap.ca/GEPPS/docs/EnglishPubli cations/eis_vf20fev09ang2.pdf [accessed June 1, 2011]. Government of Québec. 1998. The Politics of Health and Well-Being [in French]. Gov- ernment of Québec, Canada [online]. Available: http://publications.msss.gouv.qc. ca/acrobat/f/documentation/1992/92_713.pdf [accessed Mar. 3, 2011].

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169 Appendix A Government of Québec. 1999. National Public Health Priorities 1997-2002. Towards Achieving the Expected Results: 1st Report [in French]. Government of Québec, Canada [online]. Available: http://publications.msss.gouv.qc.ca/acrobat/f/documen tation/1998/98-201.pdf [accessed Mar. 3, 2011]. Government of Québec. 2001. Public Health Act. Chapter S-2.2: Article 54. Government of Québec [online]. Available: http://www2.publicationsduquebec.gouv.qc.ca/dyna micSearch/telecharge.php?type=2&file=/S_2_2/S2_2_A.html [accessed June 2, 2011]. Government of Tasmania. 1994. Environmental Management and Pollution Control Act (EMPCA). Government of Tasmania [online]. Available: http://www.environment. tas.gov.au/index.aspx?base=365 [accessed June 8, 2011]. Gulis, G., P. Gry, M.W. Fredsgaard, J. Hindhede, H. Charsmar, A. Wagner Pedersen, A. Dokkedal, and M. Martuzzi. 2008. Health Impact Assessment in New Member States Accession and Pre-Accession Countries (HIA-NMAC), Final Technical Re- port. University of Southern Denmark, Esbjerg, Denmark [online]. Available: http://ec.europa.eu/health/ph_projects/2004/action1/docs/action1_2004_frep_20_e n.pdf [accessed June 2, 2011]. Harris, P., and J. Spickett. 2011. Health impact assessment in Australia: A review and directions for progress. Environ. Impact Assess. Rev. 31(4):425-432. Hassan, A.A., M.H. Birley, E. Giroult, R. Zghondi, M.Z. Ali Khan, and R. Bos. 2005. Environmental Health Impact Assessment of Development Projects: A Practical Guide for the WHO Eastern Mediterranean Region. Geneva: World Health Or- ganization [online]. Available: http://www.who.int/water_sanitation_health/resour ces/emroehiabook.pdf [accessed July 12, 2011]. Health Canada. 2004a. Canadian Handbook on Health Impact Assessment, Vol. 1. The Basics. Health Canada. November 2004 [online]. Available: http://dsp-psd.pwgsc. gc.ca/Collection/H46-2-04-343E.pdf [accessed June 2, 2011]. Health Canada. 2004b. Canadian Handbook on Health Impact Assessment, Vol. 2. Ap- proaches and Decision-Making. Health Canada. November 2004 [online]. Available: http://www.hiaconnect.edu.au/files/hia-Volume_2.pdf [accessed June 2, 2011]. Health Canada. 2004c. Canadian Handbook on Health Impact Assessment, Vol. 3. The Multidisciplinary Team. Health Canada. November 2004 [online]. Available: http://dsp-psd.pwgsc.gc.ca/Collection/H46-2-04-362E.pdf [accessed June 2, 2011]. Health Canada. 2004d. Canadian Handbook on Health Impact Assessment, Vol. 4. Health Impacts by Industry Sector. Health Canada. November 2004 [online]. Available: https://files.pbworks.com/download/CPg0409alD/healthimpactassessment/173240 22/Canadian%20Handbook%20of%20HIA%20Vol%204%20health%20impacts% 20by%20industry%20sector%20-%20HC%20Canada%20-%202004.pdf [accessed June 2, 2011]. HEIMTSA Consortium. 2010. Health and Environment Integrated Methodology and Toolbox for Scenario Assessment (HEIMTSA) [online]. Available: http://www.hei mtsa.eu/ [accessed April 4, 2010]. Heller, J., J. Lucky, and W.K. Cook. 2009. Crossings at 29th St./San Pedro St. Area Health Impact Assessment. Human Impact Partners, Oakland, California [online]. Available: http://www.hiaguide.org/sites/default/files/Crossings_LA_29thSt_HIA_ FullReport.pdf [accessed May 17, 2011]. Héroux de Sève, J., D. Talbot, C. Druet, and M. Pigeon. 2008. Review and Outlook 2002-2007-At the Frontier of the Responsibilities of Departments: The Application of Article 54 of the Act on Public Health [in French]. Government of Québec,

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170 Improving Health in the U.S.: The Role of Health Impact Assessment Canada [online]. Available: http://publications.msss.gouv.qc.ca/acrobat/f/documen tation/2008/08-245-02.pdf [accessed Mar. 3, 2011]. Hilding-Rydevik, T., S. Vohra, A. Ruotsalainen, A. Pettersson, N. Pearce, C. Breeze, M. Hrncarova, Z. Liekovska, K. Paluchova, L. Thomas, and J. Kemm. 2005. Health Aspects in EIA. European Commission Sixth Framework Program [online]. Avail- able: http://www.umweltbundesamt.at/fileadmin/site/umweltthemen/UVP_SUP_ EMAS/IMP/IMP3-Health_Aspects_in_EIA.pdf [accessed May 23, 2011]. HM Government of Great Britain. 2007. Greater London Authority Act [online]. Avail- able: www.opsi.gov.uk/Acts/acts2007/pdf/ukpga_20070024_en.pdf [accessed June 2, 2011]. Human Impact Partners. 2009. Concord Naval Weapons Station Reuse Project Health Impact Assessment. Human Impact Partners. January 2009 [online]. Available: http://hiaguide.org/hia/concord-naval-weapons-station-reuse-project-health-impact -assessment [accessed Feb. 4, 2011]. ICMM (International Council on Mining and Metals). 2010. Good Practice Guidance on Health Impact Assessment. International Council on Mining and Minerals [online]. Available: http://www.icmm.com/library/hia [accessed July 12, 2011]. IFC (International Finance Corporation). 2006. Community Health, Safety and Security. Performance Standard 4. International Finance Corporation, April 30, 2006 [online]. Available: http://www.ifc.org/ifcext/sustainability.nsf/AttachmentsByTitl e/pol_PerformanceStandards2006_PS4/$FILE/PS_4_CommHealthSafetySecurity. pdf [accessed July 12, 2011] IFC (International Finance Corporation). 2007. General EHS Guidelines: Community Health and Safety. Environmental, Health, and Safety (EHS) Guidelines. Interna- tional Finance Corporation, April 30, 2007 [online]. Available: http://www.ifc. org/ifcext/sustainability.nsf/AttachmentsByTitle/gui_EHSGuidelines2007_General EHS_3/$FILE/3+Community+Health+and+Safety.pdf [accessed July 12, 2011]. IFC (International Finance Corporation). 2009. Introduction to Health Impact Assess- ment. International Finance Corporation, April 2009 [online]. Available: http:// www.ifc.org/ifcext/sustainability.nsf/Content/Publications_Handbook_HealthImpa ctAssessment [accessed July 12, 2011]. INTARESE Consortium. 2010. Integrated Assessment of Health Risks of Environmental Stressors in Europe [online]. Available: http://www.intarese.org/ [accessed April 29, 2010]. IPIECA/OGP (International Petroleum Industry Environmental Conservation Association and International Association of Oil and Gas Producers). 2005. A Guide to Health Impact Assessments in the Oil and Gas Industry. International Petroleum Industry Environmental Conservation Association, and International Association of Oil and Gas Producers [online]. Available: http://www.hiaconnect.edu.au/files/HIA_in_ OG.pdf [accessed May 17, 2011]. IPIECA/OGP (International Petroleum Industry Environmental Conservation Association and International Association of Oil and Gas Producers). 2007. Health Perform- ance Indicators: A Guide for the Oil and Gas Industry. OGP Report No. 393. In- ternational Petroleum Industry Environmental Conservation Association, and In- ternational Association of Oil and Gas Producers [online]. Available: http://www. ipieca.org/system/files/publications/HPI.pdf [accessed June 2, 2011]. ISAIAH. 2011. Health Corridor for All. ISAIAH, Minneapolis, MN [online]. Available: http://isaiah-mn.org/Issues/HealthyCorridorforAll.htm [accessed Feb. 4, 2011].

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171 Appendix A Ison, E. 2009. The introduction of health impact assessment in the WHO European Healthy Cities Network. Health Promot. Int. 24(suppl. 1):i64-i71. Knutsson, I., and A. Linell. 2010. Review article: Health impact assessment develop- ments in Sweden. Scand. J. Public Health 38(2):115-120. Kørnøv, L. 2009. Strategic Environmental Assessment as catalyst of healthier spatial planning: The Danish guidance and practice. Environ. Impact Assess. Rev. 29(1): 60-65. Kwiatkowski, R.E. 2004. Impact assessment in Canada: An evolutionary process. Pp. 309-316 in Health Impact Assessment: Concepts, Theory, Techniques and Appli- cations, J. Kemm, J. Parry, and S. Palmer, eds. Oxford: Oxford University Press. Kwiatkowski, R.E. 2011. Indigenous community based participatory research and health impact assessment: A Canadian example. Environ. Impact Assess. Rev. 31(4):445- 450. Kwiatkowski, R.E., and M. Ooi. 2003. Integrated environmental impact assessment: A Canadian example. Bull. World Health Organ. 81(6):434-438. Lalonde, M. 1974. A New Perspective on the Health of Canadians: A Working Docu- ment. Ministry of Supply and Services, Government of Canada, Ottawa [online]. Available: http://www.phac-aspc.gc.ca/ph-sp/pdf/perspect-eng.pdf [accessed May 31, 2011]. Laframboise, H.L. 1973. Health policy: Breaking the problem down into more manage- able segments. Can. Med Assoc. J. 108(3):388-391. Lock, K., M. Gabrijelcic-Blenkus, M. Martuzzi, P. Otorepec, P. Wallace, C. Dora, A. Robertson, and J.M. Zakotnic. 2003. Health impact assessment of agriculture and food policies: Lessons learnt from the Republic of Slovenia. Bull. World Health Organ. 81(6):391-398. London Health Commission. 2011. HIA Publications. London Health Commission [online]. Available: http://www.london.gov.uk/lhc/publications/hia/ [accessed Mar. 8, 2011]. Los Angeles Country Metropolitan Transportation Authority. 2010. I-710 Corridor Pro- ject EIR/EIS News Newsletter. January 2010 [online]. Available: http://www. metro.net/projects_studies/I710/images/I-710-Project-Update-Winter-Spring-2010. pdf [accessed Nov. 30, 2010]. Mahoney, M. 2009. Imperatives for Policy Health Impact Assessment: Perspectives, Positions, Power Relations. Ph.D. Thesis, Deakin University, Victoria, Australia. Mahoney, M., and G. Durham. 2002. Health Impact Assessment: A Tool for Policy Development in Australia. Deakin University, Geelong, Victoria, Australia [on- line]. Available: http://www.deakin.edu.au/hmnbs/hia/publications/HIA_Final_Re port_2003.pdf [accessed June 3, 2011]. Mahoney, M., S. Simpson, E. Harris, R. Aldrich, and J. Stewart-Williams. 2004. Equity Focused Health Impact Assessment Framework. The Australasian Collaboration for Health Equity Impact Assessment (ACHEIA). August 2004 [online]. Avail- able: http://www.hiaconnect.edu.au/files/EFHIA_Framework.pdf [accessed May 17, 2011]. Mall, A., S. Buccino, and J. Nichols. 2007. Drilling Down: Protecting Western Commu- nities from the Health and Environmental Effects of Oil and Gas Production. New York: Natural Resources Defense Council. October 2007 [online]. Available: http://www.nrdc.org/land/use/down/down.pdf [accessed June 3, 2011]. McKay, L. 2000. Making the Lalonde Report: Towards a New Perspective on Health Project. Canadian Policy Research Networks [online]. Available: http://cprn.org/ documents/18406_en.pdf [accessed: Apr. 28, 2011].

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172 Improving Health in the U.S.: The Role of Health Impact Assessment Mercier, J.R. 2003. Health impact assessment in international development assistance: The World Bank experience. Bull. World Health Organ. 81(6):461-462. Milio, N. 1981. Promoting Health Through Public Policy. Philadelphia, PA: F.A. Davis Company. MMS (Minerals Management Service). 2007a. Outer Continental Shelf Oil and Gas Leasing Program: 2007-2010. Final Environmental Impact Statement, Vol. 1. OCS EIS/EA MMS2007-003. U.S. Department of the Interior, Minerals Management Service, Herndon, VA. April 2007 [online]. Available: http://www.boemre.gov/5- year/2007-2012FEIS/Intro.pdf [accessed Nov. 30, 2010]. MMS (Minerals Management Service). 2007b. Chukchi Sea Planning Area Oil and Gas Sale 193 and Seismic Surveying Activities in the Chukchi Sea. Final Environ- mental Impact Statement. OCS EIS/EA MMS2007-026. U.S. Department of the Interior, Minerals Management Service, Alaska OCS Region [online]. Available: http://alaska.boemre.gov/ref/EIS%20EA/Chukchi_FEIS_193/feis_193.htm [accessed Nov. 30, 2010]. MOH (Ministry of Health). 2007. Whanau Ora Health Impact Assessment. Ministry of Health [online]. Available: http://www.moh.govt.nz/moh.nsf/pagesmh/6022/$File/ whanau-ora-hia-2007.pdf [accessed June 27, 2011]. NCCHPP (National Collaborating Centre for Healthy Public Policy). 2008. The Québec Public Health Act’s Section 54: Briefing Note. Preliminary version - for discus- sion. National Collaborating Centre for Healthy Public Policy, Québec. March 2008 [online]. Available http://www.ncchpp.ca/docs/Section54English042008.pdf [accessed June 3, 2011]. NHC Thailand (National Health Commission Office of Thailand). 2007. National Health Act, B.E. 2550 (A.D. 2007). National Health Commission Office of Thailand [online]. Available: http://en.nationalhealth.or.th/sites/default/files/fromNHCThail and/data/HealthAct07.pdf [accessed July 6, 2011]. NHC Thailand (National Health Commission Office of Thailand). 2008. HIA for HPP towards Healthy Nation: Thailand’s Recent Experiences. National Health Com- mission Office of Thailand [online]. Available: http://en.nationalhealth.or.th/sites/ default/files/fromNHCThailand/data/HIA%20for%20HPP_Final%20Version_pdf [accessed July 6, 2011]. NHMRC (National Health and Medical Research Council). 1994. Framework for Environmental and Health Impact Assessment. National Health and Medical Research Council, Commonwealth of Australia, Canberra [online]. Available: http: //www.hiaconnect.edu.au/files/NHMRC_EHIA_Framework.pdf [accessed June 3, 2011]. Nilunger, L., L.S. Elinder, and B. Pettersson. 2003. Health Impact Assessment: Screening of Swedish governmental inquiries. Eurohealth 8(5):30-32. Noble, B.F., and J.E. Bronson. 2005. Integrating human health into environmental impact assessment: Case studies of Canada’s Northern Mining Resource Sector. Arctic 58(4):395-405. Noble, B.F., and J.E. Bronson. 2006. Practitioner survey of the state of health integration in environmental assessment: The case of northern Canada. Environ. Impact As- sess. Rev. 26(4):410-424. NPHP (National Public Health Partnership). 2005. Health Impact Assessment: Legislative and Administrative Frameworks. National Public Health Partnership, Melbourne, Australia [online]. Available: http://www.dhs.vic.gov.au/nphp/work prog/lrn/legtools/hia_legframe.pdf [accessed June 3, 2011].

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173 Appendix A NPHPPHC (National Prevention, Health Promotion and Public Health Council). 2010. The National Prevention and Health Promotion Strategy, Draft Framework. Na- tional Prevention, Health Promotion and Public Health Council. October 1, 2010 [online]. Available: http://www.healthcare.gov/center/councils/nphpphc/draftframe work_pdf [accessed Nov. 30, 2010]. NSW DH (New South Wales Department of Health). 2007. Aboriginal Health Impact Statement and Guidelines. PD2007-082. Department of Health, New South Wales Government, Australia. November 12, 2007 [online]. Available: http://www. health.nsw.gov.au/policies/pd/2007/pdf/PD2007_082.pdf [accessed Nov. 30, 2010]. O’Mullane, M. 2011. Health Impact Assessment (HIA) and Institutionalisation: The Slo- vak Experience. Presentation at XI HIA International Conference, April 14-15, Granada, Spain. Opinion Leader Research. 2003. Report on the Qualitative Evaluation of Four Health Impact Assessments on Draft Mayoral Strategies for London, London Health Commission, Greater London Authority and the London Health Observatory. Opinion Leader Research, London. August 2003 [online]. Available: http://www. hiaconnect.edu.au/files/London_Mayoral_HIAs_Evaluation.pdf [accessed May 23, 2011]. Oregon Government. 2011. Health Impact Assessment [online]. Available: http://www. oregon.gov/DHS/ph/hia/index.shtml [accessed Feb. 4, 2011]. Orenstein, M., T. Fossgard-Moser, T. Hindmarch, S. Dowse, J. Kuschminder, P. McCloskey, and R.K. Mugo. 2010. Case study of an integrated assessment: Shell’s north field test in Alberta, Canada. IAPA 28(2):147-157. PHAC (Public Health Advisory Committee). 2005. A Guide to Health Impact Assess- ment: A Policy Tool for New Zealand, 2nd Ed. Wellington, New Zealand: PHAC [online]. Available: http://www.phac.health.govt.nz/moh.nsf/pagescm/764/$File/g uidetohia.pdf [accessed May 9, 2011]. Phoolcharoen, W., D. Sukkumnoed, and P. Kessomboon. 2003. Development of health impact assessment in Thailand: Recent experiences and challenges. Bull. World Health Organ. 81(6):465-467. Poirier, A. 2011a. Institutionalizing HIA in Québec: Section 54 of the Public Health Act. Presentation at XI HIA International Conference April 14-15, Granada, Spain [online]. Available: http://si.easp.es/eis2011/wp-content/uploads/2011/04/English- presentation-GrenadaInstitutionnalisationEIS-1.ppt [accessed June 3, 2011]. Poirier, A. 2011b. Beyond Health Impact Assessment: A Government Policy for Health and Well-Being. Presentation at XI HIA International Conference April 14-15, Granada, Spain [online]. Available: http://si.easp.es/eis2011/wp-content/uploads/ 2011/04/English-presentation_HIA-conference-Grenade-2.pdf [accessed June 3, 2011]. Public and Environmental Health Service. 1998. Manual for Local Government. Depart- ment of Health and Human Services, Tasmania, Australia. December 1998. Ross, C.L. 2007. Atlanta Beltline: Health Impact Assessment. Center for Quality Growth and Regional Development, Georgia Institite of Technology, Atlanta, GA [online]. Available: http://www.healthimpactproject.org/resources/document/Atlanta-Beltlin e.pdf [accessed May 18, 2011]. SFDPH (San Francisco Department of Public Health). 2011. Assessing the Health Im- pacts of Road Pricing Policy Proposals. Program on Health Equity and Sustainabil- ity, San Francisco Department of Public Health [online]. Available: http://www. sfphes.org/HIA_Tools/RoadPricing_Health_Pathways.pdf [accessed May 24, 2011].

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