Introdução: A Avaliação de Impactos à Saúde (AIS) é adotada em vários países como estratégia para abordar os potenciais impactos à saúde relacionados a políticas, planos, programas ou projetos, mas não é ainda utilizada no Brasil. Objetivo: Identificar as condições brasileiras que podem corroborar com vantagens e limitações da AIS já descritas na literatura internacional, considerando sua aplicação futura no Brasil, especialmente no caso de projetos. Métodos: Revisão da literatura científica e de outros documentos internacionais sobre AIS, identificados através de bases de dados (Pub Med e Science Direct), e de portais especializados, para entender o contexto e compilar vantagens e limitações da AIS. Revisão da literatura científica nacional e de outros documentos sobre avaliação de impactos e saúde, identificados através das bases de dados LILACS, SCIELO e outros portais brasileiros que tratam desses temas. Pesquisa qualitativa complementar com profissionais e pesquisadores brasileiros. Resultados e discussão: A AIS ainda está se desenvolvendo no mundo, por isso há vantagens e limitações igualmente importantes associadas aos seus indutores; ao objeto da avaliação (políticas, planos, programas ou projetos); à fase em que é conduzida (prospectiva ou retrospectiva); aos patrocinadores e avaliadores; ao tipo de AIS adotada; à sua institucionalização; à integração a outras formas de avaliação de impactos (AIA ou AAE); à abordagem em saúde, ao escopo e aos métodos adotados; à participação das partes afetadas e a sua influência no processo de tomada de decisão. No Brasil, os estudos que abordam os impactos à saúde são frequentemente retrospectivos e a abordagem de saúde na AIA apresenta lacunas. Os poucos estudos prospectivos ainda não utilizam as ferramentas e passos da AIS. O Ministério da Saúde vem articulando o processo de introdução da AIS no país. Conclusões e Recomendações: Há oportunidades para introduzir a AIS de projetos no país. Entretanto, é urgente o engajamento dos profissionais brasileiros da área de saúde e de avaliação de impactos com as redes de profissionais nacionais e internacionais, visando aprimorar a discussão e prepará-los para enfrentar questionamentos à AIS eventualmente levantados por aqueles que veem no processo de avaliação de impactos obstáculos para a eficiência e rapidez da tomada de decisão sobre projetos. É também preciso organizar padrões mínimos para que não sejam reproduzidos no Brasil problemas já vivenciados e solucionados em outras localidades / Introduction: Health Impact Assessment (HIA) is adopted as a strategy to address the potential health impacts associated with policies, plans, programs or projects in various countries, but not yet in Brazil. Objective: To identify the Brazilian conditions that can contribute to HIA advantages and constraints already described in the literature, considering its future adoption in Brazil, particularly in the case of projects. Method: Review of scientific literature and other documents on HIA, identified in Pub Med and Science Direct, as well as in HIA websites, in order to understand the context and compile HIA advantages and constraints already described in the literature. Review of Brazilian scientific literature and other Brazilian documents on impact assessment and health, identified through LILACS and SCIELO databases as well as other Brazilian web sites that address the subject. Additional qualitative research with Brazilian stakeholders. Results and discussion: HIA is still developing worldwide. Due to that, there are equally important advantages and limitations associated to its drivers, its object (policies, plans, programs or projects), when it is conducted (prospective or retrospective), HIA sponsors and assessors, HIA types, if HIA is institutionalized, if it is integrated with other forms of impact assessment (AIA, SEA), its approach to health, its scope and methods, the participation of affected parties and its influence to decision making. In Brazil, health impact assessments are frequently retrospective and do not adopt HIA tools and its steps. The Brazilian Ministry of Health is working to introduce HIA in the country. Conclusions and recommendations: There are opportunities to introduce HIA of projects in the country. However, it is urgent to engage Brazilian health and impact assessment professionals with national and international networks, in order to deepen and improve the discussion and to prepare them to face future questioning to HIA eventually raised by those that view the impact assessment process as an obstacle to efficiency in the context of project decision making. It is also necessary to develop minimum standards so that some issues already faced and solved elsewhere are not repeated in Brazil

Introdução: O Programa Bolsa Família é a principal estratégia brasileira para amenizar a pobreza e vulnerabilidade social, com diferentes impactos na vida dos beneficiários. O aumento da renda, em função do benefício, poderia trazer resultados positivos na alimentação, uma vez que possibilitam uma maior diversidade da dieta. Porém, poderia trazer resultados negativos como a ingestão excessiva de energia e consequente aumento da adiposidade. As avaliações dos impactos do programa em termos de obesidade e massa gorda de crianças são inexistentes. Objetivo: Avaliar o impacto do Programa Bolsa Família no estado nutricional (IMC/idade) e na composição corporal aos 6 anos de idade entre as crianças da Coorte de Nascimentos de Pelotas (RS), 2004. Métodos: Os dados foram provenientes da integração dos bancos da Coorte de Nascimentos de Pelotas de 2004 e do Cadastro Único do Governo Federal. Foi realizada análise descritiva da cobertura e focalização do programa, com informações do nascimento e dos 6 anos de idade (n=4231). Considerou-se focalização o percentual de elegíveis entre o total de beneficiários e cobertura o percentual de famílias elegíveis que são beneficiárias do programa. Nos modelos de impacto (n=3446), as exposições principais foram o recebimento do benefício: beneficiário em 2010, no período de 2004-2010; o valor médio mensal recebido e o tempo de recebimento. Foram gerados modelos de regressão linear para os desfechos score-Z do índice de massa corporal por idade (IMC/I), percentual e índice de massa gorda (IMG), e percentual e índice de massa livre de gordura (IMLG); e de Poisson, com ajuste robusto, para o desfecho obesidade (score-Z IMC/I 2), todos estratificados por sexo. As informações antropométricas e de composição corporal (BOD POD) foram obtidas do acompanhamento aos 6-7 anos de idade. Potenciais fatores de confusão foram identificados por modelo hierárquico e por um diagrama causal (DAG). Para analisar os impactos foram usadas como medidas de efeito a diferença de médias na regressão linear múltipla (IMC/I, por cento MG, IMG, por cento MLG e IMLG, variáveis contínuas) e a razão de prevalência (obesidade, variável binária). Para permanecer no modelo, considerou-se valor p0,20. A análise dos dados foi realizada por meio do software STATA. Resultados: Entre 2004-2010, a proporção de famílias beneficiárias na coorte aumentou (11 por cento para 34 por cento ) enquanto, de acordo com a renda familiar, a proporção de famílias elegíveis diminui (29 por cento para 16 por cento ). No mesmo período, a cobertura do programa aumentou tanto pela renda familiar quanto pelo IEN. Já a focalização caiu de 78 por cento para 32 por cento de acordo com a renda familiar e, de acordo com o IEN, manteve-se em 37 por cento . A média (não ajustada) de IMC e de MG dos não beneficiários foi superior a dos não beneficiários tanto em meninos quanto em meninas. Meninos do 3º tercil de valor per capita recebido e meninas com menos de 7 meses de benefício em 2010 tiveram IMC maior do que, respectivamente, aqueles dos demais tercis e daquelas com mais de 7 meses de benefício em 2010; esse padrão foi semelhante para obesidade. Meninas não beneficiárias tiveram MG maior do que as beneficiárias e superior também aos meninos, independente de ser beneficiário ou não. Em relação à MLG observou-se um comportamento contrário, no qual meninas beneficiárias tiveram maior MLG, quando comparadas com meninas não beneficiárias e, meninos quando comparados com meninas. Nos modelos de regressão ajustados, não houve diferença significativa entre beneficiários e não beneficiários em nenhum desfecho. Conclusões: De acordo com os resultados, as famílias que receberam maiores valores per capita parecem incluir crianças com maior média de IMC. O programa, nessa análise, parece não ter impacto sobre a composição corporal das crianças, nem em termos de massa gorda, tampouco em termos de massa livre de gordura. / Introduction: the Bolsa Família Program (BFP) is the main Brazilian strategy to alleviate poverty and social vulnerability, with different impacts on the lives of beneficiaries. The increase of income, depending on the benefit, could bring positive results in food consumption, since enable greater dietary diversity. However, it could bring negative results as excessive intake of energy and consequent increased adiposity. The evaluations of the impacts of the program in terms of obesity and fat mass of children are nonexistent. Objective: to evaluate the impact of BFP in nutritional status (BMI/A) and body composition to 6 years of age among children of the Cohort of Births of Pelotas (RS), 2004. Methods: data were obtained from the integration of the banks of the cohort of births of 2004 pellets and Single Record of the Federal Government. Descriptive analysis was performed of the coverage and focus of the program, with information of birth and 6 years of age (n=4231). Effect models (n=3446), the main exhibition were the approaches of the receipt of the benefit: beneficiary in 2010, in the 2004-2010 period; average monthly value and time of receipt. Linear regression models were generated for the Z-score outcomes of the body mass index for age illness (BMI/A), percentage and fat mass index (FMI), and percentage and fat-free mass index (FFMI); and Poisson, with robust adjustment for obesity outcome (score-Z BMI/A 2), all stratified by sex. The information and measurements of body composition (BOD POD) were obtained from monitoring to 6-7 years of age. Potential confounding factors were identified by hierarchical model and a causal diagram (DAG). The measures used were the average difference in multiple linear regressions (BMI/A, FM, FMI, FFM, FFMI, continuous variables) and the ratio of prevalence (obesity, binary variable). To stay at the model considered value p 0.20. Data analysis was performed using STATA software. Results: Between 2004-2010, the proportion of recipient families has increased (11 per cent to 34 per cent ); by family income eligible families number decreases (29 per cent to 16 per cent ). The coverage of the program increased both by family income as by IEN. The focus fell from 78 per cent to 32 per cent (household income) and remained at 37 per cent (IEN). The average (not adjusted) of BMI and FM of non-beneficiaries was higher in boys and girls. Boys of 3 tercil per capita value received and girls under the age of 7 months of 2010 had BMI greater benefit; this pattern was similar for obesity. Non-beneficiary girls had FM larger than the beneficiary and also higher than the boys, regardless of whether or not the beneficiary. Regarding the FFM observed a contrary behavior, in which beneficiaries girls had higher FFM, compared to non-beneficiary girls and boys compared to girls. In adjusted regression models, there was no significant difference between beneficiaries and non-beneficiaries in any outcome. Conclusions: there is evidence that the families who received largest per capita values include children with a higher average BMI. Although children beneficiaries have indexes under fat mass, the generated models showed that the program also has no effect on the fatfree mass.

Petroleum refineries emit a variety of airborne substances which may be harmful to human health. HEIDI II (Health Effects Indicators Decision Index II) is a computer-based decision analysis tool which assesses airborne emissions from Canada's oil refineries for reduction, based on ordinal ranking of estimated health impacts. The model was designed by a project team within NERAM (Network for Environmental Risk Assessment and Management) and assembled with significant stakeholder consultation. HEIDI II is publicly available as a deterministic Excel-based tool which ranks 31 air pollutants based on predicted disease incidence or estimated DALYS (disability adjusted life years). The model includes calculations to account for average annual emissions, ambient concentrations, stack height, meteorology/dispersion, photodegradation, and the population distribution around each refinery. Different formulations of continuous dose-response functions were applied to nonthreshold-acting air toxics, threshold-acting air toxics, and nonthreshold-acting CACs (criteria air contaminants). An updated probabilistic version of HEIDI II was developed using Matlab code to account for parameter uncertainty and identify key leverage variables. Sensitivity analyses indicate that parameter uncertainty in the model variables for annual emissions and for concentration-response/toxicological slopes have the greatest leverage on predicted health impacts. Scenario analyses suggest that the geographic distribution of population density around a refinery site is an important predictor of total health impact. Several ranking metrics (predicted case incidence, simple DALY, and complex DALY) and ordinal ranking approaches (deterministic model, average from Monte Carlo simulation, test of stochastic dominance) were used to identify priority substances for reduction; the results were similar in each case. The predicted impacts of primary and secondary particulate matter (PM) consistently outweighed those of the air toxics. Nickel, PAH (polycyclic aromatic hydrocarbons), BTEX (benzene, toluene, ethylbenzene and xylene), sulphuric acid, and vanadium were consistently identified as priority air toxics at refineries where they were reported emissions. For many substances, the difference in rank order is indeterminate when parametric uncertainty and variability are considered.

SUMMARY Public Health Management MANAGEMENT OF MOTORWAY TRANSPORT–GENERATED NOISE IMPACT ON HEALTH AND QUALITY OF LIFE IN LITHUANIA Žibutė Chmieliauskienė Scientific work supervisor Prof., Dr. Habil. Žilvinas Padaiga Kaunas University of Medicine, Faculty of Public Health, Department of Social Medicine. Kaunas, 2005.- 100p. Aim of the study – to investigate the process of managing transport-generated noise impact on human health and quality of life in Lithuania. Objectives: 1) to generalize investigations of managing motorway transport-generated noise identification, impact on human health and quality of life, 2) to assess the impact of the motorway AI Vilnius- Kaunas on the health of local residents and the effects on quality of life, 3) to give recommendations for the management and control of motorway-generated noise. Expected results: Justification of the management of transport-generated noise impact on human health. Methods of investigation. In order to assess motorway transport-generated noise impact on human health and quality of life the motorway AI (IX B) Vilnius – Kaunas was selected and the neighboring residential farmsteads. In each noise level zone at the interval of 5 dBA the residential farmsteads were identified: 1) respondents, living within the zone of the increased traffic noise ≥55dBA (in a day time), and 2) respondents, living within the zone of permissible traffic noise <55dBA (control group). The questionnaire inquiry was carried out, the total... [to full text]

Introdução: O Programa Bolsa Família é a principal estratégia brasileira para amenizar a pobreza e vulnerabilidade social, com diferentes impactos na vida dos beneficiários. O aumento da renda, em função do benefício, poderia trazer resultados positivos na alimentação, uma vez que possibilitam uma maior diversidade da dieta. Porém, poderia trazer resultados negativos como a ingestão excessiva de energia e consequente aumento da adiposidade. As avaliações dos impactos do programa em termos de obesidade e massa gorda de crianças são inexistentes. Objetivo: Avaliar o impacto do Programa Bolsa Família no estado nutricional (IMC/idade) e na composição corporal aos 6 anos de idade entre as crianças da Coorte de Nascimentos de Pelotas (RS), 2004. Métodos: Os dados foram provenientes da integração dos bancos da Coorte de Nascimentos de Pelotas de 2004 e do Cadastro Único do Governo Federal. Foi realizada análise descritiva da cobertura e focalização do programa, com informações do nascimento e dos 6 anos de idade (n=4231). Considerou-se focalização o percentual de elegíveis entre o total de beneficiários e cobertura o percentual de famílias elegíveis que são beneficiárias do programa. Nos modelos de impacto (n=3446), as exposições principais foram o recebimento do benefício: beneficiário em 2010, no período de 2004-2010; o valor médio mensal recebido e o tempo de recebimento. Foram gerados modelos de regressão linear para os desfechos score-Z do índice de massa corporal por idade (IMC/I), percentual e índice de massa gorda (IMG), e percentual e índice de massa livre de gordura (IMLG); e de Poisson, com ajuste robusto, para o desfecho obesidade (score-Z IMC/I 2), todos estratificados por sexo. As informações antropométricas e de composição corporal (BOD POD) foram obtidas do acompanhamento aos 6-7 anos de idade. Potenciais fatores de confusão foram identificados por modelo hierárquico e por um diagrama causal (DAG). Para analisar os impactos foram usadas como medidas de efeito a diferença de médias na regressão linear múltipla (IMC/I, por cento MG, IMG, por cento MLG e IMLG, variáveis contínuas) e a razão de prevalência (obesidade, variável binária). Para permanecer no modelo, considerou-se valor p0,20. A análise dos dados foi realizada por meio do software STATA. Resultados: Entre 2004-2010, a proporção de famílias beneficiárias na coorte aumentou (11 por cento para 34 por cento ) enquanto, de acordo com a renda familiar, a proporção de famílias elegíveis diminui (29 por cento para 16 por cento ). No mesmo período, a cobertura do programa aumentou tanto pela renda familiar quanto pelo IEN. Já a focalização caiu de 78 por cento para 32 por cento de acordo com a renda familiar e, de acordo com o IEN, manteve-se em 37 por cento . A média (não ajustada) de IMC e de MG dos não beneficiários foi superior a dos não beneficiários tanto em meninos quanto em meninas. Meninos do 3º tercil de valor per capita recebido e meninas com menos de 7 meses de benefício em 2010 tiveram IMC maior do que, respectivamente, aqueles dos demais tercis e daquelas com mais de 7 meses de benefício em 2010; esse padrão foi semelhante para obesidade. Meninas não beneficiárias tiveram MG maior do que as beneficiárias e superior também aos meninos, independente de ser beneficiário ou não. Em relação à MLG observou-se um comportamento contrário, no qual meninas beneficiárias tiveram maior MLG, quando comparadas com meninas não beneficiárias e, meninos quando comparados com meninas. Nos modelos de regressão ajustados, não houve diferença significativa entre beneficiários e não beneficiários em nenhum desfecho. Conclusões: De acordo com os resultados, as famílias que receberam maiores valores per capita parecem incluir crianças com maior média de IMC. O programa, nessa análise, parece não ter impacto sobre a composição corporal das crianças, nem em termos de massa gorda, tampouco em termos de massa livre de gordura. / Introduction: the Bolsa Família Program (BFP) is the main Brazilian strategy to alleviate poverty and social vulnerability, with different impacts on the lives of beneficiaries. The increase of income, depending on the benefit, could bring positive results in food consumption, since enable greater dietary diversity. However, it could bring negative results as excessive intake of energy and consequent increased adiposity. The evaluations of the impacts of the program in terms of obesity and fat mass of children are nonexistent. Objective: to evaluate the impact of BFP in nutritional status (BMI/A) and body composition to 6 years of age among children of the Cohort of Births of Pelotas (RS), 2004. Methods: data were obtained from the integration of the banks of the cohort of births of 2004 pellets and Single Record of the Federal Government. Descriptive analysis was performed of the coverage and focus of the program, with information of birth and 6 years of age (n=4231). Effect models (n=3446), the main exhibition were the approaches of the receipt of the benefit: beneficiary in 2010, in the 2004-2010 period; average monthly value and time of receipt. Linear regression models were generated for the Z-score outcomes of the body mass index for age illness (BMI/A), percentage and fat mass index (FMI), and percentage and fat-free mass index (FFMI); and Poisson, with robust adjustment for obesity outcome (score-Z BMI/A 2), all stratified by sex. The information and measurements of body composition (BOD POD) were obtained from monitoring to 6-7 years of age. Potential confounding factors were identified by hierarchical model and a causal diagram (DAG). The measures used were the average difference in multiple linear regressions (BMI/A, FM, FMI, FFM, FFMI, continuous variables) and the ratio of prevalence (obesity, binary variable). To stay at the model considered value p 0.20. Data analysis was performed using STATA software. Results: Between 2004-2010, the proportion of recipient families has increased (11 per cent to 34 per cent ); by family income eligible families number decreases (29 per cent to 16 per cent ). The coverage of the program increased both by family income as by IEN. The focus fell from 78 per cent to 32 per cent (household income) and remained at 37 per cent (IEN). The average (not adjusted) of BMI and FM of non-beneficiaries was higher in boys and girls. Boys of 3 tercil per capita value received and girls under the age of 7 months of 2010 had BMI greater benefit; this pattern was similar for obesity. Non-beneficiary girls had FM larger than the beneficiary and also higher than the boys, regardless of whether or not the beneficiary. Regarding the FFM observed a contrary behavior, in which beneficiaries girls had higher FFM, compared to non-beneficiary girls and boys compared to girls. In adjusted regression models, there was no significant difference between beneficiaries and non-beneficiaries in any outcome. Conclusions: there is evidence that the families who received largest per capita values include children with a higher average BMI. Although children beneficiaries have indexes under fat mass, the generated models showed that the program also has no effect on the fatfree mass.

Malgré leur potentiel important et leur introduction de plus en plus fréquente à différents niveaux politiques, le rôle des outils d’évaluation d’impact dans le processus politique reste questionné. Leur efficacité semble particulièrement limitée dans le cadre des problématiques comme la pauvreté et les inégalités sociales. Au-delà de leur complexité, c’est surtout le caractère controversé de ces phénomènes et le fait qu’il n’existe pas de consensus sur la manière d’aborder la pauvreté et les inégalités sociales, qui posent problème. Dans ce contexte, les connaissances issues d’une évaluation d’impact ne vont pas toujours jouer un rôle direct et instrumental dans la prise de décisions politiques.Dans cette thèse de doctorat, nous avons analysé comment adapter et améliorer le design et la mise en œuvre de l’outil de ‘Social Impact Assessment’ (ou de ‘Test d’impact pauvreté’), afin de mieux exploiter son potentiel d’aide à la décision en matière de lutte contre la pauvreté. Sur base d’une analyse (théorique et pratique) du fonctionnement des processus politique et décisionnels et des mécanismes de policy change, nous nous sommes intéressés aux différentes fonctions d’aide à la décision qu’il peut jouer. Nous avons identifié la fonction d’apprentissage instrumental comme la fonction la plus ‘consensuelle’ et attendue de la part des décideurs politiques, et la fonction d’apprentissage conceptuel comme la fonction potentiellement la plus puissante, mais souvent négligée et donc sous-exploitée.Via la fonction d’apprentissage instrumental, le test d’impact pauvreté doit apporter des informations précises et directement utiles à la décision. Dans cette perspective, l’accent est mis sur l’amélioration et l’optimalisation de la proposition politique, tout en respectant son cadre de référence, et en se concentrant sur ses aspects opérationnels. L’identification d’effets potentiels négatifs peut alors donner lieu à la formulation de propositions d’adaptation permettant d’atténuer voire compenser ces effets, tandis qu’un impact potentiel positif peut être davantage accentué et maximisé.Via la fonction d’apprentissage conceptuel, le test d’impact pauvreté devrait permettre d’introduire de nouvelles idées, perspectives et hypothèses qui contribuent à une compréhension plus élargie de la pauvreté, permettant ainsi de mieux appréhender les effets potentiels d’une politique sur la pauvreté. Dans cette perspective, le test d’impact pauvreté devrait contribuer, à plus long terme, à ce que les politiques publiques, quel que soit leur « secteur », puissent contribuer à une action politique globale efficace, pertinente et durable pour réduire (ou lutter contre) la pauvreté.Notre proposition de design pour le test d’impact pauvreté est guidée par le souci d’exploitation de ce double potentiel. Nous avons suivi une démarche itérative, dans laquelle nous avons développé une première proposition de design sur base (1) d’une revue de la littérature et (2) d’une analyse d’expériences en cours en matière d’évaluation d’impact sur la santé et la pauvreté en Irlande et au Québec (Canada). Cette proposition a été testée et appliquée concrètement dans des contextes de ‘real-world policy-making’. Nous avons effectué deux études de cas dans le contexte bruxellois :la première sur le projet d’ordonnance concernant le parcours d’accueil et d’intégration des primo-arrivants, la deuxième sur le projet d’assurance autonomie. Les observations faites sur le terrain, qui ont été confrontées avec des éléments issus de la littérature scientifique, ont permis d’adapter et affiner notre proposition.La proposition de design pour le test d’impact pauvreté est composée de quatre axes :(1) L’articulation du test d’impact pauvreté au timing et contraintes du processus politique et décisionnel ;(2) la clarification de ce que nous entendons par la ‘pauvreté’ et ‘l’impact sur la pauvreté’ et un schéma d’analyse des déterminants de la pauvreté, permettant d’identifier de quelle manière et à quel niveau une politique impacte la pauvreté ;(3) la proposition d’une démarche méthodologique d’évaluation, inspirée de l’approche de l’évaluation réaliste. Pour cet axe, nous avons défini une série de questions pour un test d’impact pauvreté ;(4) l’intégration des connaissances et de l’expertise des personnes en situation de pauvreté dans le test d’impact pauvreté. / Doctorat en Sciences de la santé Publique / info:eu-repo/semantics/nonPublished

This thesis presents a case study of an open pit mine proposal in Kamloops, BC. During an integrated Environmental (Impact) Assessment (EA) process mandated by the Provincial and Federal governments, stakeholders addressed the mine’s environmental, social, heritage, economic, and health-related impacts. At the end of a 7-year process, the application was denied. My research sought to examine how health was conceptualized in the EA, and, specifically, had the mine been approved, how would the permit conditions have protected the public from adverse health effects. To that end, I conducted a review of health-related documents incorporated in the EA and studied the results through a Health Impact Assessment (HIA) lens based on guidance from the International Finance Corporation (IFC). As well as reviewing and analyzing the EA documents, I conducted interviews with participants in and outside the formal stakeholder group, as prescribed by the IFC HIA Guidance. Specifically, my analysis was based on the scoping phase of the assessment, and the baseline health profile that was included, using this internationally recognized HIA framework. My results show that the social determinants of health were not factored into the EA as per HIA best practice. Many in the formal stakeholder group, and outside of it, felt that institutional barriers prevented inclusion of the social determinants of health in the assessment. That finding raises questions about the reality of EA processes to protect public health. / Graduate

En zone urbaine, la pollution atmosphérique représente un enjeu majeur de santé publique. La caractérisation du risque associé dépend fortement de la qualité de l’estimation des expositions. Si les études étiologiques s’appuient maintenant souvent sur des modèles ayant une résolution spatiale fine, les études d’impact sanitaire (EIS) reposent encore généralement sur des approches avec une faible résolution spatiale. Ces contrastes spatiaux pourraient entraîner des inégalités sociales dans la distribution de l’impact sanitaire des polluants atmosphériques. D’autres facteurs, et en particulier le bruit, partagent les mêmes sources et ont potentiellement des effets sur la santé, et devraient aussi être pris en compte dans les études épidémiologiques. Les objectifs étaient : 1. D’étudier la possibilité de modéliser la distribution des particules ultrafines (UFP) en milieu urbain, et d’évaluer la corrélation entre UFP et bruit ; 2. De réaliser une EIS des particules fines avec une résolution spatiale fine, et d’investiguer les inégalités socio-économiques dans le fardeau de maladie généré par les particules ; 3. D’estimer les bénéfices sanitaires de scénarios théoriques de réduction de la pollution de l’air à l’échelle urbaine.Le premier objectif fait partie du projet Tri-tabs, conduit dans les villes de Bâle, Gérone et Grenoble. Des mesures de 20 min du bruit routier et du trafic, mais pas des UFP, étaient fortement reproductibles sur plusieurs mois. Sur des mesures simultanées, la corrélation entre le bruit et les UFP était modérée, ce qui ouvre la possibilité d’un ajustement réciproque pour de futures études épidémiologiques, permettant ainsi de démêler leurs potentiels effets court terme.Le second objectif se focalise sur le long terme. La plupart du temps, les études d’impact sanitaire ne prennent pas en compte les variations spatiales des concentrations en polluants en zone urbaine. Dans les agglomérations de Grenoble et Lyon en 2012, l’exposition aux PM2.5 a été estimée à une échelle de 10×10 m en combinant un modèle de dispersion à des données de densité de population. Les événements de santé retenus étaient la mortalité ainsi que l’incidence du cancer du poumon (Grenoble) et des petits poids des naissances à terme. Les estimations de l’impact sanitaire ont été répétées en considérant les concentrations en polluants de façon homogène au sein de chaque agglomération. La proportion de cas attribuables à la pollution de l’air était de 3–8% pour la mortalité et 9–43% pour les petits poids de naissances à terme. A Grenoble, 6,8% des nouveaux cas de cancer du poumon étaient attribuables à la pollution de l’air. L’impact était sous-estimé de 8 à 20% lorsque les stations de mesure de fond étaient utilisées. Le risque attribuable était plus important dans les quartiers dont le niveau de défaveur sociale était intermédiaire ou légèrement au-delà.Nous avons estimé l’impact de scénarios de réduction des niveaux de particules fines. Les scénarios visant une réduction de ces niveaux de 5% permettraient une réduction d’environ 10% des décès attribuables aux particules, tandis que les actions visant à réduire uniquement la pollution chez les 10% d’habitants les plus exposés ne procureraient qu’un gain sanitaire marginal (environ 1%). En conclusion, nous avons montré que les mesures à court terme ne peuvent pas être utilisées pour modéliser les UFP en zone urbaine ; nous avons été parmi les premiers à réaliser une EIS s’appuyant sur un modèle de dispersion à résolution spatiale fine, et à avoir intégré les petits poids de naissances. Nos estimations ont montré que les stations de fond utilisées couramment en France pour les EIS tendent à sous-estimer les expositions, comparées à un modèle de dispersion. Notre estimation de la réduction des niveaux de particules fines nécessaire pour atteindre une réduction significative de l’impact sanitaire de la pollution de l’air en zone urbaine pourrait servir de guide à des politiques publiques. / In urban areas, atmospheric pollution represents a major threat to human health. The accurate characterization of this threat relies centrally on the quality of exposure assessment. It also requires assessment of other factors sharing the same sources and also possibly impacting health, such as noise. Fine-scale exposure assessment of air pollution levels may allow identifying spatial contrasts. Such spatial variations may lead to social differences in the distribution of the health impact of these pollutants.The general aims of the PhD were: 1. To study the possibility to model ultrafine particles distribution in urban areas and assess the correlation of ultrafine particles levels with road traffic noise; 2. To assess the risk incurred by air pollution exposure with a fine-scale modelling approach and investigate the potential socio-economic disparities in health burden induced by particulate matter; 3. To investigate the health benefits expected from hypothetical scenarios of reduction of air pollution levels at the urban scale.The first aim relies on Tri-tabs project, conducted in three European cities (Basel, Girona, Grenoble). Measurements during 20 minutes of outdoor noise and traffic, but not of UFP, were strongly reproducible over durations of a couple of days or months. In these areas, on the short-term, noise levels and UFP concentrations exhibited relatively moderate correlations, which may allow adjustment for mutual confounding in epidemiological studies, thus allowing to disentangle their possible short-term health effects.The second aim introduces health effects, and focuses on the longer term. Risk assessment studies often ignore within-city spatial variations of air pollutants. In Grenoble and Lyon areas (0.4 and 1.2 million inhabitants, respectively) in 2012, PM2.5 exposure was estimated on a 10×10 m grid by coupling a dispersion model to fine-scale data on population density. Outcomes were mortality, lung cancer and term low birth weight incidences. The numbers of cases attributable to air pollution were estimated overall and stratifying areas according to the European Deprivation Index, a measure of social deprivation. Estimations were repeated assuming spatial homogeneity of air pollutants within city. The proportion of cases attributable to air pollution was in the 3-8% range for mortality and 9–43% range for term low birth weight. In Grenoble, 6.8% (95% CI: 3.1–10.1%) of incident lung cancer cases were attributable to air pollution. The impact was underestimated by 8 to 20% when background monitoring stations were used to assess exposure, compared to fine-scale dispersion modeling. Health impact was highest in neighborhoods with intermediate to higher social deprivation.Several countries across Europe have implemented air pollution regulation policies, or low emission zones, France being an exception. We estimated the health impact of air pollution under different scenarios of reduction of fine particulate matter concentrations. Scenarios targeting a reduction in the PM2.5 annual averages by 5% led to a 10% decrease of the health burden, while actions aiming at only reducing the exposure of the population exposed above the 90th percentile did not yield a significant reduction of the health burden (around 1%).In conclusion, we have shown that short-term measurements cannot be used to model ultrafine particles levels in urban areas; we were among the first to rely on a fine-scale exposure model for estimating the health impact of air pollution, and quantify its impact on term low birth weight. Our estimations showed that background air quality monitoring stations used classically in France for health impact assessment studies tend to underestimate exposure, compared to a spatially-resolved dispersion model. We have provided an estimate of the air pollution decrease required to obtain a significant reduction of the health impact of air pollutants in urban areas.

While there is considerable academic research on the intersection of comprehensive plans, finance policies, zoning policies and how these factors influence real estate developers' choice of what land to develop and what buildings to construct on that land, little is understood about whether these three variables promote or hinder real estate developers' choice of whether to build communities that promote healthy living. Using urban planning theory as the foundation, the purpose of this correlational study was to determine how real estate developers' decisions are made to support healthy New Urbanism development in the United States. Secondary data from the Urban Land Institute were used for this multiple regression study that explored the degree to which comprehensive plans, finance, and zoning policies predict the likelihood that real estate developers will build New Urbanism communities in the United States. Findings indicated that comprehensive plans, finance policies, and zoning policies had a statistically significant influence on real estate developers' decisions on the types of communities to build in the United States by 53.6%, 46.8%, and 71.6% respectively p < .05. The information presented in this study is important to urban planners/designers, health care professionals, and municipal officials because of the intra and interdisciplinary approach of the built environment as a nonmedical determinant of health. Cultivating public and private collaboration to develop public policy could affect social change by directly affect the alterations and improvements in the built environment health that either promote or impede healthy outcomes.

Chemical (gaseous) emissions from wastewater treatment plants (WWTP) are perceived as odour and can generate undesirable health reactions. These could affect the quality of life to those regularly albeit intermittently exposed, although regular exposure may result in tolerance and loss of recognition of the odour. Consequently, research is necessary to establish the role of Environmental Impact Assessment (EIA) in ensuring that facilities such as WWTP do not pose a threat to local communities, particularly in relation to housing developments for poor communities. The aim of this study was to investigate if the EIA regulations were effectively implemented before building of the Residential Development Proiect (RDP) houses at KwaMathukuza, in Newcastle South Africa. Furthermore, the study intended to determine the impact the (WWTP) has on the health of people who reside close to the site and to establish if the families staying close to the WWTP have any common ailments such as handicapped babies, early deaths within families. Findings would also indicate if RDP houses should be built in close proximity to such sites. Data was collected through a survey of 85 residents living within five kilometers and ten residing beyond five kilometers from the WWTP. The participants were selected randomly. Municipality employees who worked with the WWTP were also sampled together with healthcare givers. Data included information about health of the community, their perception of the gases released from the WWTP as well as EIA meetings and processes related to the construction of the RDP houses. The outcome of this study revealed that EIA regulations were not adequately implemented and that this residential site was unsuitable for the construction of RDP houses. It emerged that the residence regularly experience unpleasant odours released from the WWTP. These could be associated with ill-health of the residents as well as v degradation the environment in general. The study also found that the effect of the WWTP affects even those communities who reside beyond five kilometers from the WWTP. The researcher argues for more stringent mechanisms to ensure that EIA regulations are properly implemented to prevent adverse effects on the communities. / Environmental Sciences / M. Sc. (Environmental Management)