Overall Introduction to Critical Appraisal 2. Finding the Evidence 3. Randomised Control Trials 4. Systematic Reviews 5. Economic Evaluations 6. Chapter 2 - Greening the Health Service Chapter 3 - Changing the Energy of the NHS Chapter 4 - Distributed Health and Service and How to Reduce Travel Chapter 5 - The End of Waste Chapter 6 - Sustainable Clinical Practice Chapter 7 - Public Health Advocacy Chapter 8 - Turning Theory into Action Chapter 9 - Theory into Action Training Change Management Collaborative Working for Health Getting the Message Across Health Everyone's Business Health Service Planning Knowledge Management Leadership and Management Policy and Strategy Development Prioritisation and Performance Management Programme and Project Management Supporting the Analyst Teaching Public Health for Action Join FPH.

Breadcrumb Home 1c - Approaches to the assessment of health care needs, utilisation and outcomes, and the evaluation of health and health care. Health and environmental impact assessment. HIAs can be carried out prospectively, concurrently or retrospectively.

HIA can be used to inform: The design and development of a policy or strategy The commissioning of services Resource allocation Community participation and service user involvement Community development and planning Preparing funding bids HIA involves 6 main steps: Screening: a selection process which assesses policies, programmes and projects for their potential to affect the health of the population.

It offers a systematic way of deciding whether a HIA is worth doing. Scoping: usually a steering group encompassing all the organisations involved will be formed and will set the boundaries for appraisal of health impacts.

They will also agree the way in which the appraisal will be managed and allocate responsibility for decision-making. Appraisal: this is the main part of the HIA and can be rapid, intermediate or comprehensive. To ensure that the views of local communities are heard a comprehensive HIA is the most effective.

Appraisal includes analysing the policy, programme or project; profiling the affected population; identifying and characterising the potential health impacts, looking at the evidence base and making recommendations for the management of the impacts. Presenting results: unless total consensus is reached, results should be presented as a range of options.

Decision-making: The ultimate result will be an agreed set of recommendations made by the steering group for modifying the project such that its health impacts are optimised. Implementing, monitoring and evaluating: impacts of HIA processes are monitored to enhance the evidence base for future HIAs.

Outcome evaluation is constrained by the fact that negative impacts which have been successfully avoided due to the modification of the project will not be clearly identifiable.

It is the emphasis that is different. EIA seeks to examine the environmental consequences of development actions. HIA attempts to assess the impacts of a development, program or policy on the health of the population. As humans are part of the environment, overlap between the two is common.

However traditionally EIA has restricted itself to only examining the potential harmful effects a development may have on the immediate community.

This assessment is generally confined to environmental hazards such as chemical contamination. HIA attempts to expand this knowledge to look at the social, economic, lifestyle and behavioural costs and benefits to the immediate community as well as the 'downstream' direct and indirect impacts that will occur in other communities.

At a policy or program level, HIA is more akin to Strategic Environmental Assessment SEA , although the focus is human health impacts rather than environmental impacts. Secretariat health.

au if you would like to receive an electronic copy of the publication. In NSW, the Centre for Health Equity Training Research and Evaluation CHETRE is currently working to integrate HIA into the NSW Health System. You may be trying to access this site from a secured browser on the server.

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The HSEIA then involves an environmental impact assessment EIA , a control of major accident hazards COMAH and an occupational health risk assessment OHRA. We then look at the bigger picture to see what changes can be made in the way the client works.

An HSE impact assessment will then be conducted to demonstrate that:. TARGET CUSTOMERS. The HSEIA process can take place at four distinct stages of a construction project. The following four phases are defined for the project-approval process:.

KEY CUSTOMER BENEFITS. Accept Reject Settings. Enable Disable. Reject all cookies Accept all cookies. In recent literature on, for example, climate change, discussion about adaptation has tended to focus on deliberate institutional responses to risk, primarily through policy.

More generally, however, adaptation involves a complex and recursive process of individual response, not only to the risks themselves but also to the resulting policies or other interventions [ 7 ]. These collective and individual adaptations may take a long time to manifest themselves, both because of in-built latencies within the system e.

the lag between exposure and expression of a health outcome , and because the initial perturbation may trigger a long chain reaction of response as the effects spread out through the wider system. Adjustments may thus continue for many years or even centuries.

Nor are the states at the start and end of this process necessarily some form of stasis or equilibrium, both because internal dynamics such as ageing or evolution may mean that change is inherent, and because other externally driven perturbations may disrupt the system before it can become fully adjusted.

Many systems thus remain in a state of perpetual flux. The dynamics of environmental health systems have important implications for assessment, for they mean that the results are dependent on the timeframe used.

Comparisons of simple snapshots in time, representing before and after conditions, for example, are likely to underestimate the true impacts because they fail to take account of the possibly substantial effects of intervening adaptations.

Assessments based on short timeframes are also likely to be misleading, for they will ignore the longer-term consequences both of the initial intervention and subsequent adaptive responses.

Even so-called life cycle approaches, in which assessment is continued for the duration of the policy or product, may neglect more persisting legacies, such as inter-generational effects. If these long-lasting effects are to be considered, the timeframes for assessment may need to be extremely and somewhat arbitrarily extended.

In a life cycle analysis of emissions from a modern landfill site, for example, Camobreco et al. Such long timeframes may not only be difficult to rationalise in the more short-term world of policy-making, but also of course add to the uncertainties inherent in the analysis.

Nevertheless, in the face of dynamic and adaptive behaviours, static scenarios are clearly limited. While they may be useful in addressing general questions about the desirability of different policy goals, they give limited guidance on the likely consequences of trying to achieve these outcomes.

In most cases, therefore, adaptive scenarios — or endogenous scenarios in the terminology of Carter and La Rovere [ ] — are likely to be more informative. These do not define the ultimate state of the system, but instead specify the changes in input conditions; modelling is then done to simulate the way in which these move through the system, and the resulting system state.

They are, as such, closer to projections or predictions than mere narratives or visions of some alternative world. Consequently, they are prey to all the inevitable uncertainties involved in modelling system behaviour.

These uncertainties can be substantial in the case of environmental processes, where data are sparse, model parameterisation only approximate and non-linearity may rule. They are liable to become even greater, however, in the case of social systems that depend on human behaviours, for these are not always easy to predict and may seem to go against the purpose of the intervention or the collective good [ 7 ].

Adaptation, it needs to be remembered, is an intrinsic and largely individual phenomenon, and as such is each person's response to the perception of the world from within.

As Hardin's [ ] well-known parable of the 'tragedy of the commons' illustrates, from this perspective rational behaviour may look very different from that of the outside observer.

The growing complexity of issues facing policy-makers, and the increasing demands for more inclusive and 'joined-up' policy have highlighted the need for more integrated methods of assessment to guide decision-taking. This need is especially acute in the area of environmental health, where the complexities of human activities, environmental processes, and human well-being come together.

By extending the principles of integrated assessment, as previously developed mainly in the field of environmental policy, to human health much of this need can be addressed.

As this paper has indicated, however, the application of such integrated approaches to environmental health assessment brings many challenges. Chief among these are questions of how to deal properly with the multi-causality, non-linearity and change processes inherent in most analyses.

Together these problems emphasise the need for careful and rigorous issue-framing and scenario specification as the foundation for assessment.

How to achieve this, especially in the context of multiple stakeholders with varying interests and levels of expertise, is itself challenging.

Conducting rigorous assessments of the scenarios thus defined presents further difficulties, not least because of gaps in data, limitations of knowledge and the inevitable amplification of uncertainties involved in devising and parameterising complex and linked models.

These knowledge deficits, in turn, have important implications for the supporting sciences especially of epidemiology and toxicology — not least in demanding higher levels of understanding about the multivariate and time-varying interdependencies and interactions between environment and health.

Many research challenges thus remain. If the larger problems that increasingly face society are to be resolved, however, these are all challenges that need to be taken up. Health and Environment Integrated Methodology and Toolbox for Scenario Assessment EU funded research project.

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Hardin G: The tragedy of the commons. Download references. The work presented herein was undertaken in the context of two studies funded under the European Union 6 th Framework Programme: INTARESE and HEIMTSA. I gratefully acknowledge the financial support provided by the EU through these projects.

Whilst responsibility for the views and opinions expressed here lies with me along, in developing these ideas I have received much stimulus and advice from many partners in these two projects; I thank all those concerned for this stimulation and help.

In particular, I would thank Erik Lebret, Anne Knol and Irene van Kamp RIVM, Netherlands and Mike Joffe Imperial College London for helping to shape my thoughts on this topic. Department of Environmental Epidemiology and Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.

You can also search for this author in PubMed Google Scholar. Correspondence to David J Briggs. This paper is the sole work of the author, who has been responsible for researching the issues covered, developing most of the new ideas and concepts contained herein, and preparing the paper. This article is published under license to BioMed Central Ltd.

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Abstract Traditional methods of risk assessment have provided good service in support of policy, mainly in relation to standard setting and regulation of hazardous chemicals or practices. Introduction Environmental effects on health have always been multi-facetted. Review Assessment in the context of risk governance Recognition of the systemic nature of risks to human health has stimulated a vigorous debate within the policy arena about how best to develop and guide policies in the context of complexity.

Integrated environmental health impact assessment: a conceptual framework As already noted, the various methods of risk and health impact assessment developed over recent years have resulted in a somewhat confused situation. Figure 1. Full size image. Figure 2. Conclusion The growing complexity of issues facing policy-makers, and the increasing demands for more inclusive and 'joined-up' policy have highlighted the need for more integrated methods of assessment to guide decision-taking.

Abbreviations HEIMTSA: Health and Environment Integrated Methodology and Toolbox for Scenario Assessment EU funded research project INTARESE: Integrated Assessment of Health Risks from Environmental Stressors in Europe EU funded research project IPCS: Intergovernmental Panel on Climate Change IRGC: International Risk Governance Council REACH: Registration, Evaluation, Authorisation and Restriction of Chemical substances EU Regulation WHO: World Health Organisation.

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