People with disabilities are a ‘disadvantaged’ group, not only due to their impairment, but also due to the formal and informal institutional inertia that they contend with in Western Societies. This disadvantage has been recognised and acknowledged in the social model of disability. This model understands that disability is a social construction placed on people with impairments. The Health Impact Assessment (HIA) is a tool which identifies inequities in policy, and is potentially a useful tool to aid the response of policy makers to the needs of people with disabilities. Arguably, the New Zealand HIA guidelines reflect the underlying principles of the social model of disability. Using a mixed methods research strategy, this thesis sets out to understand in a global context using a top-down quantitative analysis, to what extent the New Zealand HIA guidelines which acknowledge the social model of disability are translated into practice. It then subsequently investigates from a bottom-up qualitative perspective, what factors influence this relationship. It is argued in this thesis that there are barriers to translating the rhetoric about people with disabilities found in the HIA guidelines into practice. Three sets of inter-related barriers identified include attitudinal barriers to people with disabilities, generic HIA barriers, and barriers related to the feminist interpretation of the construction of disability. In this thesis, the research findings conclude that it is difficult to operationalise the disability awareness present in the HIA guidelines due to barriers which are related to the ‘othering’ of people with disabilities. This is discussed in relation to feminist analyses of the construction of people with disabilities, and it needs to be addressed by wider societal reforms. The thesis makes the recommendation that a national awareness-raising campaign about people with disabilities be undertaken in New Zealand in an attempt to rectify this situation.

A significant number of studies have identified clear links between chronic health issues, including asthma, obesity, and diabetes, and the design of the built environment. As shapers of the built environment, urban planners can play a central role in ameliorating these current health epidemics. Indeed, during the early history of the planning profession the fields of planning and public health were closely connected, and improved public health was seen as a key mission of the planning profession. Today, however, public health issues are not a central concern in planning, neither as a normative value of the field nor as a core element of daily planning practice. Instead, health is a value-based cause taken up by concerned practicing planners, who face numerous challenges in incorporating a health focus into their daily work. This research argues that there is a need for a focus on health outcomes within the planning field, based on the initial mission of planning discipline and current research showing the impact of the built environment on public health. Through a nationwide survey of planners and interviews with planning and health professionals in five cities, findings show that collaboration between health and planning departments is key to instilling a health focus within the practice of planning. Planners who seek to promote a health focus in planning are pursuing this value-based imperative through a variety of ad-hoc strategies, since existing regulations and professional guidelines are inadequate in terms of facilitating collaboration between public health and planning in order to systematically address health issues related to land use and the built environment. Research also shows that collaboration between planning and public health departments, when this does occur, is often initiated and driven by processionals in the public health discipline. Though planners and health professionals who have sought to collaborate have faced institutional, political, and awareness challenges, there are opportunities that can be leveraged to overcome these obstacles. These opportunities include the professional expertise available in the public health field, the availability of health data in order to reframe planning issues, and the potential of individual champions of health to drive health considerations in planning projects, and promote health as a normative value. Ultimately, individual planners who see the creation of healthier communities as central to their professional practice pursue collaborative strategies with health professionals despite the challenges they face. From the perspective of collaborative planning theory and theories of institutional change, this individual engagement and initiative by planners through their everyday practice has the potential to effect institutional change by forging a focus on health as a normative value central to the planning discipline. / text

Particulate matter (PM) is one of the most studied and problematic pollutants due to its toxicity and relati­vely high concentrations. This thesis aims to clarify the main sources and exposures of PM in Tallinn and Tartu, study the associations with health effects, and estimate the extent of those effects with health impact assessment (HIA). It appeared that the main sources of particulate air pollution in Tallinn (the capital of Estonia) and Tartu (the second largest city of Estonia) are local heating and traffic, inclu­ding road dust. In addition to local emissions, particulate levels are affected by transboundary pollution. If the transboundary air masses originated from the Eastern European areas, the concentration as well as the oxidative capacity of fine particles was significantly higher in urban background air in Tartu compared to air masses coming from Scandinavian areas (Paper I). During the last 15 years, traffic increase has been very fast in Tartu. However, due to the improvement in vehicle technology during this period, there has been only a slight increase in concentration of exhaust particles (Paper II). Nevertheless, a greater increase in road dust emissions was detected. A statistically significant relationship between long-term exposure to those traffic induced par­tic­les and cardiac disease in the RHINE (Respiratory Health in Northern Europe) Tartu cohort was shown (Paper III). However, no significant associations with respira­tory health were found. The HIA in Tallinn demonstrated 296 (95% CI = 76–528) premature deaths annually, because of PM (Paper IV). The average decrease in life expectancy was predicted to be 0.64 (95% CI 0.17–1.10) years. However, among risk groups it can be higher. In addi­tion, several cardiovascular hospitalizations are related. The costs to society be­cause of health effects reach up to €150 million annually (95% CI = 40–260) from pre­mature deaths and hospitali­zation constitute an additional €0.3 million (95% CI = 0.2–0.4). The special HIA scenario, when more pollution fuel peat will be used in boiler houses was analysed as well (Paper V). It indicated that peat bur­ning would result in up to 55.5 YLL per year within the population of Tartu. However, the health effects of pollution from current traffic, local heating, and industry are at least 28 times bigger. In conclusion, exposure to PM cause considerable health effects in the form of cardio­pulmo­nary diseases in main Estonian cities.

There is an increasing number of international migrants worldwide and in Canada. The majority of migrants arrive with a health status higher than the average of their host country. This advantage is often lost within ten years of migration due to various reasons, most notably through the social determinants of health. These determinants are the conditions in which individuals live and work and the most relevant to migrant health include racialization, education, employment, housing, social capital, and gender. Health impact assessment (HIA) is a process with the capacity to address changes in health due to the social determinants of health by assessing the intended and unintended impacts on health that a policy, program, or project might have and recommend ways to promote positive and mitigate negative impacts. For this reason, HIA has the potential to address the observed decrease in health experienced by migrants. Various frameworks have been developed to guide the undertaking of HIA including frameworks explicitly aiming at addressing health inequities by considering particular socially disadvantaged population groups. One such example is the Health Equity Impact Assessment (HEIA) tool developed by the Ontario Ministry of Health and Long-Term Care. Although there have been a few studies addressing the inclusion of inequities in HIA in general, there has been no previous assessment of the inclusion of migrants in HIA. This doctoral thesis sought to assess the degree and way in which migrants are included in HIAs globally and across various types of HIAs and contexts. It also sought to assess the degree to which migrants were considered in local initiatives through an examination of the implementation of the Ontario HEIA tool in public health units. A scoping review of the international literature including 117 HIAs and two HIA evaluations found that only 14% of hand-searched HIAs mentioned migrants, 5% analysed migrants and only 2% included them in their recommendations. Although migrant groups were sometimes included in the process, this was seldom the case for citizens. The main reported barriers to considering migrants were a lack of available data and the significant additional resources needed. In order to undertake an evaluation throughout the province, it was first necessary to assess the way in which the Ontario HEIA had been implemented and used by public health units across the province. The scan found that nearly half of public health units had used the HEIA tool either in its original form or modified to the needs of the unit. The use of the tool was found to be influenced by the following factors: the available inputs or resources, the nature of the HIA tool, the actors and stakeholders involved, the decision-making processes within the unit or team involved, the context of the social, economic, and political environments, the nature of the project, program, or policy being assessed, and lastly, the various outputs of completing the HEIA process. Lastly, a Process and Impact evaluation assessed the way in which PHUs with a high proportion of migrants considered these migrants in their HEIAs. This study found that although migrants had been included in HEIAs, this tended to be done when the impact on migrants was anticipated. Additionally, there remains an incoherent terminology accompanied by a confounding of the concepts of migration, racialization, and ethnicity, which are reflected in the type of recommendations developed. These recommendations often focused on translation of documents into various languages and the acquiring of greater information through community partnerships. The process and capacity to include migrants in HEIAs were influenced by the availability of resources and evidence, the prioritisation of recommendations relating to migrants, and the overall impressions the staff had on the HEIA process. Nonetheless, the HEIA process was beneficial in that it strengthened relationships with migrant community organisations. This thesis work also resulted in the development of a HIA-specific theoretical framework based on the literature and empirical findings of this work. This framework is conducive to adopting a tactical approach to HIA by considering the various contextual factors influencing the completion of an HIA and implementation of its recommendations. In conclusion, although migrants are understood to be an important group often facing circumstances of disadvantage, they are only sometimes considered in HIAs. Several procedural and contextual barriers are encountered which influence their consideration. Significant guidance is still required to facilitate their adequate consideration and ensure the development of optimal recommendations. HIA frameworks should explicitly mention migrants as a potentially disadvantaged group and guidance documents could be developed to address the current gaps in understanding migrant issues.

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Härtill 5 uppsatser. Även tryckt utgåva.

Performance measurement and management have been evolving at state Departments of Transportation (DOTs) in recent years, and a variety of performance data is being utilized in different ways to guide decision-making processes. However, health considerations beyond air quality and safety are not yet being incorporated into performance management programs at state DOTs. Concurrently, Health Impact Assessments (HIAs) and other public health tools have seen increasing use among Metropolitan Planning Organizations (MPOs) and their stakeholders through collaboration with public health professionals. With the 2012 reauthorization of the surface transportation bill - Moving Ahead for Progress in the 21st Century (MAP-21) - state DOTs and MPOs have the opportunity to consider health proactively in transportation decision making to address the environmental sustainability requirements of MAP-21. This study investigates the possibility for integration between transportation performance measurement and management and the HIA approach, identifying and explaining the linkages between the two previously isolated processes. The study draws from best practices in performance measurement/management at state DOTs and various examples of health-related activities among MPOs and other planning to inform a suggested approach for incorporating health considerations and metrics in transportation decision making. The suggested approach recognizes common goals of health and transportation agencies, which are well-aligned with national objectives, and emphasizes the role of multidisciplinary interagency collaboration and partnership. This approach is intended to be a resource for state DOTs and MPOs that are interested in extending their performance measurement/management activities to formally include health considerations, as it can ease many of the implementation issues currently faced when considering broader health impacts of transportation.

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.

Health impact assessments for fine particulate matter (PM2.5) often rely on simulated concentrations generated from air quality models. However, at the global level, these models often run at coarse resolutions, resulting in underestimates of peak concentrations in populated areas. This study aims to quantitatively examine the influence of model resolution on the estimates of mortality attributable to PM2.5 and its species in the USA. We use GEOS-Chem, a global 3-D model of atmospheric composition, to simulate the 2008 annual average concentrations of PM2.5 and its six species over North America. The model was run at a fine resolution of 0.5 × 0.66° and a coarse resolution of 2 × 2.5°, and mortality was calculated using output at the two resolutions. Using the fine-modeled concentrations, we estimate that 142,000 PM2.5-related deaths occurred in the USA in 2008, and the coarse resolution produces a national mortality estimate that is 8 % lower than the fine-model estimate. Our spatial analysis of mortality shows that coarse resolutions tend to substantially underestimate mortality in large urban centers. We also re-grid the fine-modeled concentrations to several coarser resolutions and repeat mortality calculation at these resolutions. We found that model resolution tends to have the greatest influence on mortality estimates associated with primary species and the least impact on dust-related mortality. Our findings provide evidence of possible biases in quantitative PM2.5 health impact assessments in applications of global atmospheric models at coarse spatial resolutions.

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: 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