Conference Program: 4th Asia Pacific Regional Conference on Health Impact Assessment (HIA), Seoul, South Korea, 9-11 October 2012

“HIA for increasing healthy life expectancy and well-being”

제4회 아시아태평양 건강영향평가국제학술대회주제 : 건강수명연장과 웰빙을 위한 건강영향평가

•일시 : 2012년 10월 9일(화)~11일(목)

•장소 : 한국보건사회연구원

http://hia.kihasa.re.kr/eng

국제회의 자료집1005_국제회의 자료집 2012-10-08 오후 5:17 페이지 1

The 4th Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera)


The 4th Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) | 3

Welcoming remark

I am pleased to invite you to the Fourth Asia-Pacific HIA Conference, which will be held

October 9~11, 2012, in Seoul.

Governments around the world have of late increasingly employed HIA as a useful tool to

predict the health effects of policies and programs. HIA is also effective in addressing health

disparity issues including unequal distributions of health effects across groups of differ-

ent socioeconomic backgrounds. The Conference will focus on, among many other things,

the how HIA can be instrumental to increasing people's healthy life expectancy and well-

being.

During the conference, the Thematic Working Group on Health Impact Assessment will also

be holding its Fourth Meeting, to discuss HIA issues and to report on the progress of the

Workplan 2010-2012.

I sincerely hope that you will join us at the Conference and enrich the discussion with your

perspectives and insights.

Dr. Byong-ho TchoePresident, KIHASA


4 | Korea Institute for Health and Social Affairs, Seoul, Korea

A. Date : October 9-11, 2012

B. Venue : Korea Institute for Health and Social Affairs, Seoul, Korea

C. Background

With the tool of Health Impact Assessment we can prevent diseases and injuries in a community and countryby providing recommendation for healthy public policy in development projects, programs and policies.Countries have increasingly implemented HIA recently, because HIA is a useful tool to protect health by pre-dicting the positive and negative health effects of a policy, a plan, a program, or a project and by recommendingproper measures to enhance the positive health effects and to minimize the negative health effect. HIA alsoaddresses health disparity issues including unequal distributions of health effects on people with different socioe-conomic backgrounds.While many countries have exerted efforts to implement HIA in the region, there exist some challenges in thepractice of HIA. We need some clear mechanism in institutionalization of HIA and guidelines with standardizedmethodology and tools that can be utilized in different sectors. We need more evidence for the HIA practice inthe region, because many sources of evidence have come from the Western countries. Capacity building andtraining are another important issue in the region. We need technical support and investment for HIA as well.

D. Aim of the Conference

The 4th Asia Pacific Regional Conference is to provide an opportunity for sharing knowledge with regard toevidence based HIA practices, and to promote wide range of implementation of HIA in different sectors.Hopefully, this conference can increase the opportunity for investment in HIA in the region.

E. Theme of the Conference

“HIA for increasing healthy life expectancy and well-being”

Key Themes in HIA- Determinants of health and healthy lifestyles- Equity oriented HIA- Evidence based approach- Practice of HIA : barriers and challenges- Capacity building and training- Institutionalization of HIA- Evaluation of HIA- International cooperation

Related issues in HIA- Linking HIA with other forms of impact assessment- Development projects and investment- Natural disaster- Climate change- Other environmental issues- Aging population and global burden of diseases- Participatory approach

F. Organizing committee

- Conference organizing committee : Dr. Eun Jin Choi and KIHASA researchers, Dr. Eun JeongKang(SoonChunHyang Univ), Dr. Young Soo Lee(KEI), Yoo Geun Heag(MOHW), Hyen Mi Chung(WPRO)

Conference information



Conference Information

a.m. (9:30-12:30)

Lunch(12:30-01:30)

p.m.(1:30-05:00)

9 Oct. (Tuesday) 10 Oct. (Wednesday) 11 Oct. (Thursday)

Opening ceremony(09:30-10:00)

Plenary session(10:00-12:30)

Chair: Dr. Yoon hyung Park (Soonchunhyang University)

Recent developments in HIA – a high-level overviewof HIA in a global context(Michaela Pfeiffer, WHO)

Challenges to implementing HIA: ADB Perspective(Genandrialine Peralta, ADB)

Health Impact Assessment, a process of harnessingwisdom or squeezing in data?

(Domyung Paek, Seoul National University)

Health Impact Assessment in England(I)(John Kemm, JK Public Health Consulting)

Growing the Field of Health Impact Assessment in theUnited States: A Status Report

(Andrew L. Dannenberg, University of Washington)

KIHASA

Scientific session(01:30-05:00)

Chair : Dr. Yun-Chul Hong(Seoul National University)

The RAPID guidance; a tool for policy oriented HIA

(Gabriel Gulis, University of Southern Denmark)

Application of Exposure Science and Risk Assessmentin HIA

(Kiyoung Lee, Seoul National University)

HIA in ASEAN Community(Tanita Suwanakitti, National Health Commission Office)

Training and capacity building of different implemen-tation models in three Danish local municipalities

(Peter Gry, University of Southern Denmark)

Impact of electrification on human health – evidencefrom rural Bhutan

(Ganesh P. Rauniyar, ADB)

Embed Health Impact Assessment into Free TradeNegotiation Processes

(Nusaraporn Kessomboon, Khon Kaen University)

The Need and Readiness for Health ImpactAssessment of the Organizations in Thailand(Phen Sukmag, Prince of Songkla University)

Community Based Project Management: a PromisingApproach for Alleviating Sub Standard Neighborhood

in Indonesia(Ansawi Manafl, Diponegoro University)

Multisectoral Participatory Approach for HealthImpact Assessment in Cambodia

(Prak Raingsey, Ministry of Health, Cambodia)

Determination of Environmental Factors thatInfluenced Cholera Outbreak in Catanduanes

Province, Philippines (Ms. Maia Sonabel Anarna, Department of Health,

Philippines)

Gala dinner at 6:00

Plenary session(9:30-10:30)

Chair : Dr. Hisashi Ogawa(Former regional advisor, WHO WPRO)

Health, EIA, and major projects: working towards more inte-grated approaches

(Richard Morgan, University of Otago)

Health Impact Assessment: Triumph over common sense?(Ben Harris-Roxas, University of New South Wales)

Health Impact Assessment in England (II)– Some points ofdebate

John Kemm(JK Public Health Consulting)

Regional seminarChair : Dr. Hyenmi Chung(WHO W PRO)(10:40-12:30)

Health Impact Assessment Capacity Development in Vietnam(Nguyen Thi Lien Huong, Ministry of Health, Vietnam)

Integration of HIA into the EIA report in Vietnam(PHAM Hoai Nam, Ministry of Natural Resources and

Environment, Vietnam)

Is HIA Effective for Top Level Administrative Plan?(Young Soo Lee, KEI)

The potential health effects of climate change on the elderlypopulation in Korea

(Yoon Shin Kim, Hanyang University)

Health Impact Assessment in Healthy Cities in Korea(Dongjin Kim, KIHASA)

Using community knowledge in promoting health: Examplesfrom two case studies in Seoul

(Jinhee Kim, Seoul National University)

KIHASA

Regional SeminarChair : Dr. Hisashi Ogawa

(Former regional advisor, WHO WPRO)

Health Impact Assessment in China(Jin Yinlong, IEHRP, China)

Health Impact Assessment in Mongolia(Tsetsegsaikhan B., Ministry of Health, Mongolia)

Health in EIA : Thailand’s Experiences(Siriwan Chandanachulaka, Ministry of Public Health, Thailand)

HIA on Dam Construction in Korea(Young Soo Lee, KEI)

Scientific sessionChair : Dr. Hyenmi Chung(WHO WPRO)

Health Impact Assessment of Settlement Re-developement:A Case from Low-income Area of Small City in South Korea

(Kwang Wook Koh, Kosin University)

The Experience of Health Impact assessment of ImmunizationProgram in Jinju City, Korea

(Keon Yeop Kim, Kyungpook National University)

Association of Part-Time Work and Suicide Attempts amongKorean Adolescent Students: a National Cross-Sectional

Survey(Sun-Jin Jo, Catholic University of Korea)

The Impact of Socioeconomic Environment on Local SuicideMortality: Evidence from a Spatial Analysis(Eunjeong Kang, Soonchunhyang University)

Bacterial and Fungal Profile and Antimicrobial SusceptibilityPattern from Patients of Chronic Suppurative Otitis Media

with Special Emphasis on Seasonal Variation at Civial HospitalKarachi Pakistan

(Maria Shoaib, Dow University of Health Sciences)

TWG Business

Meeting

(9:30-12:30)

Chair : Dr. Eun JinChoi(KIHASA)

(1:30-3:30)

Expert meeting

&

Closing of the conference

KIHASA



Country Name Affiliation

Dr Prak Piseth Raingsey

Dr. Jin Yinlong

Mrs. Vilayvone MANGKHASEUM

Dr. Tsetsegsaikhan B.

Ms. Maria Sonabel Anarna

Dr. Eun Jin Choi

Dr. Young Soo Lee

Ms. Siriwan Chandanachulaka

Dr. Nguyen Thi Lien Huong

Dr. PHAM Hoai Nam

Cambodia

China

Lao People's Democratic Republic

Mongolia

Philippines

Republic of Kroea

Thailand

Vietnam

Vietnam

Ministry of Health

Institute for Environmental Health andRelated Product Safety

Ministry of Health

Ministry of Health

Department of Health

KIHASA

KEI

Ministry of Public health

Ministry of Health of Vietnam

Ministry of Natural Resources andEnvironment

Participants

• Dr. Nasir Hassan (Team Leader-Environmental Health, Building Healthy Communities & Population, WHO WPRO)

• Dr. Hisashi Ogawa (Former Regional advisor, WHO WPRO)

• Dr. CHUNG Hyenmi (Technical Officer, Environmental Health Team, WHO WPRO)

• Dr. Michaela Pfeiffer (Technical Officer, WHO)

• Dr. Genandrialine L. Peralta (SeniorSafeguardsSpecialist(Environment), Asian Development Bank)

• Dr. John Kemm (Public Health Consulting Ltd., UK)

• Dr. Gabriel Gulis (Univ. of Southern Denmark)

• Dr. Andy Dannenberg (Affiliate Professor, University of Washington, CDC, USA)

• Dr. Richard Morgan (Univ. of Otago, New Zealand)

• Dr. Ben Harris-Roxas (Harris-Roxas Health, Australia)

Thematic Working Group on Health Impact Assessment

Korean Speakers

- 강은정 (순천향대학교 조교수)

(Eunjeong Kang, MPH, Ph.D.; Assistant Professor; Soonchunhyang University, Department of Health Administrationand Management)

- 고광욱 (고신대학교 의과대학 교수)

(Kwang Wook Koh, MD, Ph.D.; Professor: Kosin University College of Medicine, Graduate School of Public Health)

- 김건엽 (경북대학교 의과대학 교수)

(Keon Yeop Kim, MD, Ph.D.; Professor: Kyungpook National University School of Medicine)

- 김동진 (한국보건사회연구원 부연구위원)

(Dongjin Kim, Dr.PH; Associate Research Fellow: Korea Institute for Health and Social Affairs)

- 김윤신 (한양대학교 의과대학 교수)

(Yoon Shin Kim, MPH, DrHSc, PhD; Professor: Hanyang University, College of Medicine, Dept. of Occupational& Environmental Medicine)


The 4th Asia and Pacific Racific Regional Health Impact Assessment Conference(Seoul, Koera) | 7

- 김진희 (서울대학교 보건대학원)

(Jinhee Kim, MPH; PhD Candidate, Seoul National University)

- 남은우(연세대학교 보건과학대학 교수)

(Eun Woo Nam, MPH, Ph.D.; Professor: Yonsei University College of Health Sciences)

- 박윤형(순천향대학교 의과대학 교수)

(Yoon hyung Park, MD. Ph.D.; Professor : Soonchunhyang University, College of Medicine, Department ofPreventive medicine)

- 백도명(서울대학교 보건대학원 교수)

(Domyung Paek, MD, MSc, ScD: Professor: Seoul National University Graduate School of Public Health)

- 이기영 (서울대학교 보건대학원 교수)

(Kiyoung Lee, ScD, CIH; Professor: Seoul National University Graduate School of Public Health)

- 이영수 (한국환경정책평가연구원 선임연구위원)

(Young Soo Lee, Ph.D.; Senior Research Fellow: Korea Environment Institute)

- 조선진 (가톨릭대학교 의과대학 연구교수)

(Sun-Jin Jo, MPH, PH.D.; Research Assistant Professor: The Catholic University of Korea College of Medicine)

- 최은진 (한국보건사회연구원 연구위원)

(Eun Jin Choi, Ph.D.; Research Fellow: Korea Institute for Health and Social Affairs)

- 홍윤철 (서울대학교 의과대학 교수)

(Yun-Chul Hong MD, Ph.D; Professor: Seoul National University College of Medicine)

Keynote Speech Themes Recent developments in HIA – a high-level overview of HIA in a global context(Pfeiffer, Michaela, World Health Organization, Geneva, Switzerland)

Challenges to implementing HIA: ADB Perspective(Genandrialine Peralta, Patricia Moser, Asian Development Bank, Manila, Philippines)

The RAPID guidance; a tool for policy oriented HIA(Gabriel Gulis, University of Southern Denmark, Esbjerg, Denmark)

HIA News from the West(John Kemm, M.A., M.D., F.F.C.M., F.R.C.P., United Kingdom)

Health Impact Assessment, a process of harnessing wisdom or squeezing in data? (Domyung Paek, Seoul National University, Seoul, Korea)

Health, EIA, and major projects: working towards more integrated approaches(Richard K. Morgan, Professor, Department of Geography, University of Otago, Dunedin, New Zealand.)

Health Impact Assessment: Triumph over common sense?(Ben Harris-Roxas, Conjoint Lecturer, Centre for Primary Health Care and Equity, University of New South Wales, Australia;Consultant, Harris-Roxas Health; Health Section Co-Chair, International Association for Impact Assessment)



Growing the field of Health Impact Assessment in the United States: A Status Report(Andrew L. Dannenberg, MD, MPH, University of Washington & National Center for Environmental Health, Centers for DiseaseControl and Prevention, U.S.A.)

Application of Exposure Science and Risk Assessment in HIA(Kiyoung Lee,Seoul National University, Seoul, Korea)

Health Impact Assessment in Healthy Cities in Korea(Dongjin Kim, Korea Institute for Health and Social Affairs, Seoul, Korea)

Is HIA Effective for Top Level Administrative Plan?(Young Soo Lee, Korea Environment Institute, Seoul, Korea)

Scientific Sessions and presentersBacterial and Fungal Profile and Antimicrobial Susceptibility Pattern from Patients of Chronic Suppurative OtitisMedia in Civil Hospital Karachi (C.H.K.); (Maria Shoaib, Dow University of Health Sciences, Karachi, Pakistan)

Estimating the effect of health state on intergenerational poverty in Senegal(Hounkpodote Hilaire Guy Adetona, University Cheikh Anta Diop of Dakar (UCAD), Dakar, Senegal)

Training and capacity building of different implementation models in three Danish local municipalities(Peter Gry, University of Southern Denmark, Esbjerg, Denmark)

Impact of electrification on human health – evidence from rural Bhutan(Ganesh P. Rauniyar, Asian Development Bank, Metro Manila, Philippines)

Entrench Health Impact Assessment into Free Trade(Kessomboon Nusaraporn, Khon Kaen University, Thailand)

HIA in ASEAN Community(Suwanakitti Tanita, National Health Commission Office, Bangkok, Thailand

The Need and Readiness for Health Impact Assessment of the Organizations in Thailand(Phen Sukmag, Prince of Songkla University, Songkla, Thailand)

Community Based Project Management: a Promising Approach for Alleviating Sub Standard Neighborhoodin Indonesia(Dr. –Ing. Asnawi Diponegoro University, Semarang, Indonesia)

The Impact of Socioeconomic Environment on Local Suicide Mortality: Evidence from a Spatial Analysis(Eunjeong Kang, Soon Chun Hyang University, Asan, Korea)

Association of Part-Time Work and Suicide Attempts among Korean Adolescent Students: a National Cross-Sectional Survey(Sun-Jin Jo, Department of Preventive Medicine, College of Medicine, the Catholic University of Korea, Seoul, Korea)

Using community knowledge in promoting health: Examples from two case studies in Seoul(Jinhee Kim, Graduate School of Public Health, Seoul National University, Seoul, Korea)

The potential health effects of climate change on the elderly population in Korea(Yoon Shin Kim, Hanyang University, Seoul, Korea)

Health Impact Assessment of Settlement Re-developement: A Case from Low-income Area of Small City inSouth Korea(Kwang Wook Koh, Kosin University, Busan, Korea)

The Experience of Health Impact assessment of Immunization Program in Jinju City, Korea(Keon Yeop Kim, Kyungbuk University, Daegu, Korea)

HIA on Dam Construction in Korea(Young Soo Lee, Korea Environment Institute, Seoul, Korea)



Summary of speech andabstracts

http://hia.kihasa.re.kr/eng

The 4

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Contents

Recent developments in HIA – a high-level overview of HIA in a global context ___________________________________________________ 11

Challenges to implementing HIA: ADB Perspective _____________________________________________________________________________ 13

Health Impact Assessment Practice in England (9th October 2012)_______________________________________________________________ 15

Health Impact Assessment in England – Some topics of debate (10th October 2012) _______________________________________________ 16

Growing the Field of Health Impact Assessment in the United States: A Status Report ____________________________________________ 17

The RAPID guidance; a tool for policy oriented HIA ____________________________________________________________________________ 19

Health, EIA, and major projects: working towards more integrated approaches.___________________________________________________ 20

Health Impact Assessment: Triumph over common sense? _____________________________________________________________________ 23

BACTERIAL AND FUNGAL PROFILE AND ANTIMICROBIAL SUSCEPTIBILITY PATTERN FROM PATIENTS OF CHRONIC SUPPURATIVE OTITIS MEDIA WITH SPECIAL EMPHASIS ON SEASONAL VARIATION AT CIVIL HOSPITAL KARACHI PAKISTAN. ____ 25

Estimating the effect of health state on intergenerational poverty in Senegal ____________________________________________________ 26

Training and capacity building of different implementation models in three Danish local municipalities ______________________________ 27

Impact of electrification on human health – evidence from rural Bhutan __________________________________________________________ 28

Embed Health Impact Assessment into Free Trade Negotiation Processes _______________________________________________________ 29

HIA in ASEAN Community ___________________________________________________________________________________________________ 30

The Need and Readiness for Health Impact Assessment of the Organizations in Thailand.__________________________________________ 31

Community Based Project Management: a Promising Approach for Alleviating Sub Standard Neighborhood in Indonesia _____________ 32

Health Impact Assessment, a process of harnessing wisdom or squeezing in data? _______________________________________________ 33

Application of Exposure Science and Risk Assessment in HIA ___________________________________________________________________ 34

Is HIA Effective for Top Level Administrative Plan? ____________________________________________________________________________ 35

HIA on Dam Construction in Korea ___________________________________________________________________________________________ 36

Health Impact Assessment in Healthy Cities in Korea __________________________________________________________________________ 37

Using community knowledge in promoting health: Examples from two case studies in Seoul _______________________________________ 38

The potential health effects of climate change on the elderly population in Korea _________________________________________________ 39

Health Impact Assessment of Settlement Re-developement: A Case from Low-income Area of Small City in South Korea ___________ 40

The Experience of Health Impact assessment of Immunization Program in Jinju City, Korea _______________________________________ 41

The Impact of Socioeconomic Environment on Local Suicide Mortality: Evidence from a Spatial Analysis ____________________________ 43

Association of Part-Time Work and Suicide Attempts among Korean Adolescent Students: a National Cross-Sectional Survey_______ 44

Health Impact Assessment Capacity Development in Vietnam __________________________________________________________________ 45

MultisectOral PARTICIPATORY APPROACH FOR HEALTH IMPACT ASSESSMENT IN CAMBODIA __________________________________ 47

Determination of Environmental Factors that Influenced Cholera Outbreak in Catanduanes Province, Philippines ____________________ 49

Health Impact Assessment in Mongolia _______________________________________________________________________________________ 50

Health in EIA : Thailand’s Experiences ________________________________________________________________________________________ 51

Integration of HIA into the EIA report in Vietnam ______________________________________________________________________________ 52



Recent developments in HIA – a high-level overview of HIA in a global context

This presentation will provide a high-level overview and perspective on recent developments in HIA

that could serve as a backdrop for some of the more detailed discussions about HIA methods,

experience and practice that will follow. HIA applications (and perspectives) will be described in four

contexts: 1) the global health arena; 2) Rio+20, sustainable development and a green economy; 3)

development finance and in particular in relation to environmental and social safeguards applied to

large infrastructure projects; and 4) in the context of building country capacities to respond to

specific demands posed by a particular industry. Regionally relevant examples are provided

where possible.

Following is an annotated outline of some of the main points that will be covered under each of the

four headings:

1. HIA in the global health arena:HIA is gaining renewed visibility as an instrument for health in all

policies (HiAP), tackling non-communicable diseases, and for addressing health equity gaps

through action on social determinants of health. Reference will be made to HIA expert meetings

and consultations including in Kobe (June 2012) and in Quebec (August 2012).

2. HIA in the context of sustainable development:Health is a prerequisite and measure of sustain-

able and equitable/fair development. In Rio+20 (June 2012) HIA was recognized as a key instru-

ment for integrating health into wider sustainable development/green economy policies and

investments and for monitoring and measuring the impact of these policies on human well-being.

Examples will be drawn from the findings of WHO research (using HIA tools and methods) on the

health risks and benefits associated with “green” policies proposed in three priority sectors: 1) urban

transport, 2) housing and the built environment; and 3) household energy.

3. HIA and development finance:Many multilateral financial institutions, such as the World Bank, its

private sector lending arm – the International Finance Corporation (IFC), and regional development

banks like the Asian Development Bank, use environmental and social performance requirements or

safeguards to ensure that the projects they finance (e.g. dams) do not harm the environment and near-

by communities. In 2007, the IFC introduced a specific performance requirement for community health

and safety. Since then, WHO has been actively engaged with the banks to enhance coverage of pub-

lic health issues within their safeguard systems. HIA is the main instrument used to do this.

Pfeiffer, Michaela1

1: World Health Organization, Geneva, Switzerland



4. HIA as an instrument for strengthening country systems –HIA applied at the sectoral or strate-

gic level (i.e. at the level of industry) can facilitater the identification of wider and cumulative health

impacts that result from multiple projects and activities. HIA, when applied at this level, can also

identify health systems services and capacities needed (e.g. chemical incident response) to respond

to those health issues if and when they arise. Examples and insights will be drawn from the pilot

that under-development in Mongolia’s mining sector.

Key words : Health impact assessment, Sustainable development, Health in all policies

Contact information:Ms Michaela V PfeifferPublic Health and Environment DepartmentWorld Health Organization20 Avenue Appia, CH-1211 Geneva 27Switzerland

Phone: +41 22 791 2379Fax: +41 22 791 1383E-mail: [email protected]



Challenges to implementing HIA: ADB Perspective

Through its Strategy 2020 (2008-2020), ADB1 has five core specializations that best support its agen-

da: (i) infrastructure; (ii) environment, including climate change; (iii) regional cooperation and inte-

gration; (iv) financial sector development; and (v) education. To contribute to public health, ADB invests

in water, sanitation, waste management systems, rural infrastructure, covering irrigation and water

management, rural roads, and rural electrification. In urban infrastructure, ADB focuses on water sup-

ply, sanitation, waste management, and urban transport.

ADB works through the project cycle, from project identification, feasibility study, project prepara-

tion, project/loan processing, negotiations, approval, effectiveness then project implementation

with supervision, monitoring and reporting until completion and evaluation. Lessons are learned through-

out the project cycles which are fed into new projects as they are developed and implemented. Some

examples shall be provided on typical ADB-financed public sector infrastructure projects to illustrate

the various stages of the project cycle over time, and possibly illustrate how health impacts could be

considered at each stage.

There is an assumption that all development projects can improve human health. Currently ADB does

not take into account health benefits of a project in the calculation of EIRR, economic internal rate of

return. Presumably the inclusion of health benefits would raise the EIRR but the challenge is how to

do it, quickly and reasonably.

Within ADB, there is a polarity of thinking on the best approach to take on HIA - whether the safe-

guards approach or health optimization through infrastructure projects. Both are being practiced but

there is no agreement yet on which one works best. Infrastructure is the largest ADB sector comprising

70% of projects by volume, with the 30% accounted for the finance sector development and edu-

cation sector (combined with health, agriculture, and the other sectors). Through 70% infrastruc-

ture projects, ADB could make a difference in people’s health, through application of health impact

assessment (HIA), as part of environmental impact assessment (EIA), a requirement in project pro-

cessing. In this environmental assessment, a rapid environmental checklist is prepared at the begin-

ning of the project for environmental categorization (such as A, B, or C) and to allocate proper time

and resources on the assessment during project preparatory stage.

Genandrialine Peralta, Patricia Moser

Asian Development Bank, Manila, Philippines

1 The Asian Development Bank was founded in 1966 and it has its headquarters in Manila, Philippines. It now has 67 member countriesand 30 country offices with the mission to have an Asia and Pacific free from poverty (1.8 billion poor people are in this region). With$22 billion in approved financing in 2011, more than 2,900 employees from 59 countries work towards fighting poverty in Asia and Pacific.ADB provides loans, grants, policy dialogue, technical assistance and equity investments in both public and private sectors. It has a mul-tidisciplinary staff consisting of economists, sociologists, engineers, gender and health experts, and environmental scientists.



Specifically this is covered in the Safeguard Policy Statement (SPS 2009) which requires either an Initial

Environmental Examination (IEE) for Category B project or an Environmental Impact Assessment (EIA)

for Category A project. Health is considered with regards to protection of health of workers and com-

munities, i.e. (i) occupational health and safety and (ii) community health and safety. These are both

included in every IEE/EIA report. To comply with the SPS, Borrowers have to follow applicable

national and local regulatory requirements, relevant international conventions, as well as identify sig-

nificant environmental impacts and implement mitigation measures to reduce the potential impacts.

In addition, the Borrower conducts public consultations to engage and inform local communities, stake-

holders, civil societies and NGOs about the project and its potential impacts.

In the last 20 years, ADB published two HIA guidelines on development projects and programs where

identifying environmental impacts were seen to be important intermediate steps in the causation of

health impacts and their prevention or mitigation. In this case, EIA is actually part of HIA. The

International Finance Corporation already requires ESHIA or Environmental, Social, and Health

Impact Assessment. However, evidence based health impact assessments are still challenging to under-

take and this might be the reason why the World Bank and other regional banks including ADB have

not followed this approach towards ESHIA.

There are ways to consider health impacts with environmental impacts throughout the project cycle.

One suggestion is at the upstream stage, where project or site selection could be undertaken early

on for alternatives which have greater potential for producing health outcomes. This paradigm shift

might be a better approach rather than the safeguard approach. ADB works with other internation-

al financing institutions to harmonize and unify their requirements and alignment with country sys-

tems under the 2005 Paris Declaration on Aid Effectiveness and the Accra Agenda for Action.

Keywords: development projects, health impacts, EIA

Contact Information:Dr. Genandrialine L. PeraltaSeniors Safeguards Specialist (Environment)Southeast Asia Regional DepartmentAsian Development Bank6 ADB Avenue, Mandaluyong City1550 Metro Manila, PhilippinesTel: (632) 683-1726Fax: (632) 636-2336Email: [email protected]

Ms. Patricia MoserLead Health SpecialistRegional Sustainable Development DepartmentAsian Development Bank6 ADB Avenue, Mandaluyong City1550 Metro Manila, PhilippinesTel: (632) 632-6329Fax: (632) 636-2336Email: [email protected]



Health Impact Assessment Practice in England (9th

October 2012)

HIA is used to assist in making a decision and to predict the future consequences of choosing differ-ent options. People may request an HIA because they want information on that decision or recom-mendations on how to implement the decision. More frequently and less properly they may requestan HIA to demonstrate that the decision they have already taken is right or to oppose or support aparticular decision. The main benefits of an HIA are an informed decision allowing the decisionmaker to make better trade offs between their various objectives and make decisions that are bet-ter for health. Additional benefits are greater understanding between different disciplines and agen-cies and greater understanding of health in the community.

Attempts to predict the future consequences of the various options may be based on epidemiology/toxicology or on social sciences and participation. An epidemiologist attempts to estimate future expo-sure levels and then use dose response curves to predict the consequences. This approach is easierto apply to causal paths involving pollutants and noise than to other causes. Those who rely on par-ticipation seek to assess the consequences by listening to the hopes and fears of those affected.

Full scoping is key to a successful HIA. This involves clarifying the decision and the boundaries to theenquiry, identifying the stake holders, deciding the types of evidence to be used, considering the causalpathways, the process for reporting and the type of HIA to be done. The final report should includerecommendations for mitigation, enhancement and monitoring.

HIA can also be used to improve (national) policy but when applied to policy HIA needs slightly dif-ferent methods to HIA for projects.

Keywords: Benefits of HIA, Scoping HIA, Recommendation in HIA, HIA of Policy

John Kemm

JK Public Health Consulting, Bromsgrove, UK



Health Impact Assessment in England – Some topics ofdebate (10th October 2012)

HIA has to attempt to describe the magnitude of impacts. Quantitative approaches attempt to do thisusing numbers while qualitative approaches use ordinal scales in words. Lack of information and detailedunderstanding of mechanisms make it rare for impacts to be successfully quantitated. Criteria mustbe specified to make ordinal scales meaningful.

The Gothenburg consensus statement suggested values for HIA. Ethical use of evidence impliesimpartiality. There is a temptation to use HIA as an advocacy tool but this raises problems and is notcompatible with impartiality. WHO and many national governments are trying to promote health equi-ty and HIA can support this by describing the distribution of impacts.

Decision makers are now asked to undertake a wide range of impact assessments and this canbecome a considerable work burden. There is therefore a strong case for integrating health impactassessment with other impact assessments though this does carry the risk that health will be giveninadequate consideration. In England (and in the European Union) all policies are subject to an inte-grated impact assessment which has to be published. At the moment health is not well covered in thissystem but it is probably wiser to argue for an improvement of health coverage in the existing sys-tem rather than to ask for additional HIA.

Key Words : Magnitude of impacts, Modelling, HIA Values, Advocacy, Equity, Integrated ImpactAssessment.

Contact information : John Kemm


e-mail : [email protected]

John Kemm




Growing the Field of Health Impact Assessment in theUnited States: A Status Report

Overview- Timeline – major events that contributed to HIA growth in the US

- Rapid growth in U.S. especially in past 5 years

- Number of HIAs completed to date

- Sectors in which HIAs have been completed

- Number of HIA papers with US authors and journals in which they are published

Examples of HIAs in US- Trinity Plaza housing redevelopment, San Francisco

- Housing rental voucher program, Boston

- Coal-fired power plant, Florida

- Mass transit funding, California

Institutionalization

- National policies and reports supportive of HIA

•National Prevention Strategy, 2011

•White House Task Force on Childhood Obesity, 2010

•CDC Transportation and health recommendations, 2011

•National Research Council Committee on Health Impact Assessment report, 2011

- Recommendations of the National Research Council HIA report

•Encourage use of HIA

•Use peer review to ensure quality of HIAs

•Incorporate HIA into NEPA EIA process

•Use quantitative models when possible

•Engage stakeholders

•Build capacity to conduct HIAs

•Evaluate impacts of HIA

•Manage expectations of what HIA can do

HIA and Environmental Impact Assessment/National Environmental Policy Act•Integration of HIA and EIA

•Alaska HIA program

Andrew L. Dannenberg, MD, MPH

Affiliate Professor, University of Washington



Level of complexity of HIA: qualitative versus quantitativeVoluntary versus regulatory HIAs

- Required HIAs in US

•HIA of State Route 520 bridge replacement, Seattle

•HIAs required by Massachusetts Healthy Transportation Compact

- Legal review of state and local laws supportive of HIA

(http://www.healthimpactproject.org/resources/body/Legal-Review.pdf)

HIA Evaluation- Group Health/RWJF evaluation project, 26 site visits, web survey of HIA practitioners

•Preliminary observations

Capacity building- Eight university level courses on HIA now being taught

- National HIA meetings in the US

- SOPHIA – Society of Practitioners of Health Impact Assessment (www.hiasociety.org)

Future of HIA in the US- Challenges

•Funding

•Quantitative vs qualitative analyses

•Need for more evaluation

•Anti-regulatory environment

•Capacity to conduct HIAs

- Opportunities

•Growing interest

•Support in major national documents

•Evidence of successes

•Addresses social equity/health disparities

Further resources- www.cdc.gov/healthyplaces

- www.healthimpactproject.org

Contact information : Andrew L. Dannenberg, MD, MPHCarter Consulting, Inc.Consultant, Healthy Community Design InitiativeNational Center for Environmental Health, Centers for Disease Control and PreventionAffiliate Professor, University of Washington Cell 404-272-3978; Email [email protected]: www.cdc.gov/healthyplaces



The RAPID guidance; a tool for policy oriented HIA

Introduction: In addition to projects and plans HIA aims to assess also potential health impacts ofpolicies and strategies. Due to complexity of policies this is a rather complicated task requiring timeand resources. The “Risk assessment from policy to impact dimension - RAPID” project funded byEuropean Commission aimed to develop a systematic guidance to enhance policy oriented HIA.

Methods: A consortium of 11 partners from across Europe conducted a set of case studies on riskassessment of policies and based on them developed the RAPID guidance. The guidance has been test-ed via conduct of risk assessment of European Commission health strategy and a series of nationalworkshops in participating countries.

Results: The main product of the project is the RAPID guidance in form of a checklist addressing alllevels of the full chain approach (policies – determinants of health – risk factors – health outcome). Itis structured on four levels containing task to do and advice how to do.

Discussion: Quantification (changes in determinants, risks factors, health outcomes), differences betweendeterminants of health and risk factors, uncertainties and their interactions and horizontal prioriti-zation were identified as main issues where more research is needed.

Conclusions: The RAPID guidance seems to be a promising tool well received by risk assessors andHIA experts moreover also by representatives of other sectors. However, the guidance needs to betested under different context to verify its global validity.

Key words : Risk assessment, policy, health impact assessment

Contact information:Gabriel Gulis, PhD, associate professorUnit for health promotion research, University of Southern Denmark, Niels Bohrsvej 9-10, 6700 Esbjerg,phone 0045 65504212, fax 004565504283, e-mial [email protected]

Gabriel Gulis

University of Southern Denmark, Esbjerg, Denmark



Health, EIA, and major projects: working towards moreintegrated approaches.

Project-level environmental impact assessment is well established around the world, so there are sound

reasons for integrating health considerations into those existing assessment practices, rather than

viewing HIA as a separate stand-alone process for project assessment. However, although this has

been recognised for many years (e.g. Davies and Sadler, 1997; Ahmad, 2004), progress on the whole

has been disappointing. For example, Harris et al. (2009) report a low level of health-oriented con-

tent in 25 project EIAs in New South Wales, Australia, and similar findings have been reported else-

where (e.g. Bhatia and Wernham, 2008; Morgan, 2008; 2011).

One response to this slow progress has been a renewed call for stronger HIA, with a separate iden-

tity, to ensure health is considered alongside “environmental” concerns (e.g. Negev et al., 2012). However,

there is the danger that by seeking to maintain a separate identity, this could in itself work to the detri-

ment of those wishing to ensure health considerations are given their due weight in project decisions.

Rather than pulling back from EIA, it would be useful to examine why EIA practitioners have been slow

to respond to the HIA community’s call for greater attention to health in project-level assessments.

In this presentation I explore some of the issues that may be impeding improvements in the treat-

ment of health within EIAs, with the intention of stimulating reflection and discussion.

I start with the question of expectations: HIA advocates have expectations of how health should be

addressed in impact assessment and consider EIA practice to be failing when it does not meet those

expectations. In very broad terms, HIA usually emphasises a wide view of health, to include social

determinants, and the notion of wellbeing. Other characteristics include a strong participatory

approach, transparency, a particular concern for health inequalities, and seeking opportunities to achieve

health benefits. Many HIAs are seen as being initiated and often conducted by, or on behalf of, pub-

lic health authorities. And it is often said that HIA brings unique methodological values that EIA lacks

(community input, equity concerns, etc.).

In contrast, EIA processes are often situated within strong institutional frameworks that tend to dic-

tate their form. Practices can easily become entrenched over the years so that observed practice in

a given jurisdiction may not represent good EIA practice principles so much as procedural expediency.

In that context, project-proponents and EIA practitioners may not welcome the pressure to carry out

an HIA in addition to an EIA. This negative view may be exacerbated by claims from HIA practition-

ers to be introducing improvements to EIA, in the shape of community and stakeholder participation

and concern for equity. Finally, the assertion that HIA is concerned with health and wellbeing, which

Richard K. Morgan

Professor, Department of Geography, University of Otago, Dunedin, New Zealand.



encompass all aspects of the natural, social and cultural environment (so subordinating all EIA to the

cause of health), and that the EIA process should be leveraged to identify positive outcomes for health,

will further alienate the very practitioners who will be needed if health considerations are to be given

greater prominence in EIAs.

I believe HIA needs to scale back its expectations, recognise that EIA theory and practice principles

are already highly developed (but, yes, too often poorly practised), and that it is more effective for

health impact practitioners to fit into current EIA practice and then to modify it from within, rather

than to expect EIA to adjust to the HIA view of the world.

This suggests a number of issues HIA practitioners might want to reflect on. For example:

• At the project level, proponents are usually responsible for commissioning impact assessment stud-

ies, within a framework that reviews them quality and adequacy. So public health authorities/health

agencies should not conduct HIAs for projects: their role should be to advise local authorities, pro-

ponents, and impact assessment practitioners about health issues at the scoping stage, and to review

the treatment of possible health impacts within EIAs.

• Health impact practitioners should focus on extending health considerations within EIA from the

current environmental health approach to address wider health determinants.

- This means working collaboratively with, for example, social and cultural impact assessors, then

extending their work to examine health consequences.

- It also means developing ways to bring all health impacts together into a coherent analysis of

total health burden, and to feed health equity issues into the wider treatment of distributional

issues in the EIA.

• Health policy agendas need to be downplayed in project level impact assessment, and the focus

kept on “health”, not on the rather nebulous notion of wellbeing.

• The health sector concept of “intervention” that often seems to influence HIA approaches needs

to be modified or dropped in the context of project-level HIA. It places too much attention on estab-

lishing definitive cause-effect links between project activities and possible health outcomes. EIA

does not demand the same level of certainty, because it is based on “prevention” as opposed to

“intervention” thinking.

• On the other hand, EIA information used in project decisions does need to be grounded, and health

professionals need to understand how to tailor their information to the needs of the decision-mak-

ing process.

In return, HIA practitioners can reinvigorate EIA processes that in many countries have become

mechanical, have drifted away from basic impact assessment principles, or lost touch with the latest

thinking about new methods and techniques. And through the use of health, they can help bind the

various threads of the impact assessment together, and make the link back to local communities.



Overall, I feel a more considered approach to building health considerations into project-level EIA will

rebuild trust and respect for HIA among the wider impact assessment community and provide the basis

for a truly integrated approach.

References.

Ahmad, B.S. (2004) Integrating health into impact assessment: challenges and opportunities. Impact

Assessment and Project Appraisal, 22: 2-4

Bhatia R., and Wernham, A. (2008) Integrating human health into environmental impact assessment:

an unrealised opportunity for environmental health and justice. Environmental Health

Perspectives, 116: 991-1000

Davies, K., and Sadler, B. (1997). Environmental Assessment and Human Health: Perspectives,

Approaches, and Future Directions. Ottawa: Health Canada.

Harris, P.J., Harris, E., Thompson, S., Harris-Roxas, B. and Kemp, L. (2009) Human health and well-

being in environmental impact assessment in New South Wales, Australia: Auditing health impacts

within environmental assessments of major projects. Environmental Impact Assessment

Review, 29: 310–318

Hilding-Rydevik, T., Vohra, S., Ruotsalainen, A., Pettersson, A., Pearce, N., Breeze, C., Hrncarova, M.,

Liekovska, Z., Paluchova, K., Thomas, L. and Kemm, J. (2006) Health Aspects in EIA. D 2.2

Report WP 2. Improving the Implementation of Environmental Impact Assessment (IMP)3, Sixth

Framework Programme, European Commission.

Morgan RK. (2008) Institutionalising health impact assessment: the New Zealand experience. Impact

Assessment and Project Appraisal, 26: 2-16.

Morgan, R.K. (2011) Health and impact assessment: Are we seeing closer integration? Environmental

Impact Assessment Review, 31: 404–411

Negev, M., Levine, H., Davidovitch, N., Bhatia, R. and Mindell, J. (2012) Integration of health and envi-

ronment through health impact assessment: Cases from three continents. Environmental

Research, 114: 60-67

Contact information:Professor Richard K. Morgan http://www.geography.otago.ac.nz [email protected] for Impact Assessment Research and Training (CIART) Department of Geography/ Te IhowhenuaUniversity of Otago / Te Whare Wananga o Otago P.O. Box 56Dunedin New Zealand/Aotearoawork phone: (+64)-3-479-8782



Health Impact Assessment: Triumph over commonsense?

Evaluations of health impact assessments (HIAs) have highlighted its potential impacts on decision-making, implementation and broader factors such as intersectoral collaboration (Harris-Roxas et al.2011, Harris-Roxas et al. 2012b, Wismar et al. 2007). Tensions often arise between stakeholdersabout the outcomes of HIAs however. Studies that have looked at this have found that there are:

• Often disagreements between stakeholders about the perceived purpose of the HIA and whatform it should take (Harris-Roxas et al. 2012a, Harris-Roxas & Harris 2011); and

• The perception that an HIA’s recommendations could have been identified through normalplanning and implementation processes and that the HIA didn’t necessarily have to be conducted(Harris-Roxas et al. 2011). In other words, that an HIA’s recommendations are “commonsense”.

These two issues, about the perceived purpose of HIA and the “common sense” nature of HIAs’ rec-ommendations, lie at the heart of any discussion of the HIA effectiveness. These issues have also beenunder-explored in the literature to date.

This plenary will present initial findings from a study that looked at two decision-support equity-focusedHIAs of similar health sector proposals (local health service obesity prevention and treatment ser-vice plans) longitudinally. This involved conducting 23 semi-structured interviews with key stakeholdersbefore, during and after the HIAs, and document reviews. One of the HIAs was completed while theother one was screened and determined to be unnecessary. This study is unique in relation to HIA tothe authors’ knowledge, because it looks at expectations and perceptions of effectiveness before andafter the HIAs were completed. It also compares two similar planning situations, one in which an HIAwas conducted and one in which the HIA was screened out.

The study’s findings highlight that while many of the recommendations and distal impacts of an HIA(Harris-Roxas & Harris 2012) could notionally be anticipated through common sense analysis, in prac-tice they are rarely foreseen. A similar phenomenon has been demonstrated in other fields such asorganisational psychology and management (Orrell 2007, Watts 2011). This study also highlights thecritical role that learning plays in impact assessment practice (Morgan 2012, Bond & Pope 2012). Thislearning takes three forms: technical, conceptual and participatory (Harris & Harris-Roxas 2010,Glasbergen 1999). Learning may also take place at individual, organisational and social levels.

This suggests that common sense is anything but common in the real world of planning and decision-making. What seems obvious in hindsight is rarely apparent in advance. HIA, as a structured processfor looking at under-considered impacts, has an important role to play in moving beyond commonsense towards broader learning and more nuanced analyses of alternatives.

Ben Harris-Roxas

Conjoint Lecturer, Centre for Primary Health Care and Equity, University of New South Wales, Australia; Consultant, Harris-Roxas Health;

Health Section Co-Chair, International Association for Impact Assessment



References.

Bond A, Pope J (2012) The State of the Art of Impact Assessment in 2012, Impact Assessment andProject Appraisal, 30(1):1-4. doi:10.1080/14615517.2012.669140

Glasbergen P (1999) Learning to Manage the Environment in Democracy and the Environment: Problemsand Prospects (Eds Lafferty W and Meadowcroft J), Edward Elgar: Cheltenham, p 175-193.

Harris-Roxas B, Harris E (2011) Differing Forms, Differing Purposes: A Typology of Health ImpactAssessment, Environmental Impact Assessment Review, 31(4):396-403.doi:10.1016/j.eiar.2010.03.003

Harris-Roxas B, Harris E (2012) The Impact and Effectiveness of Health Impact Assessment: A con-ceptual framework, Environmental Impact Assessment Review:accepted, in press

Harris-Roxas B, Harris P, Harris E, Kemp L (2011) A Rapid Equity Focused Health Impact Assessmentof a Policy Implementation Plan: An Australian case study and impact evaluation, InternationalJournal for Equity in Health, 10(6), doi:10.1186/1475-9276-10-6.http://www.equityhealthj.com/content/10/1/6

Harris-Roxas B, Harris P, Wise M, Haigh F, Ng Chok H, Harris E (2012a) Health Impact Assessmentin Australia: Where we’ve been and where we’re going in Past Achievement, Current Understandingand Future Progress in Health Impact Assessment (Ed Kemm J), Oxford University Press:Oxford, p accepted - in press.

Harris-Roxas B, Viliani F, Bond A, Cave B, Divall M, Furu P, et al. (2012b) Health Impact Assessment:The state of the art, Impact Assessment and Project Appraisal, 30(1):43-52.doi:10.1080/14615517.2012.666035

Harris E, Harris-Roxas B (2010) Health in All Policies: A pathway for thinking about our broader soci-etal goals, Public Health Bulletin South Australia, 7(2):43-46.http://www.dh.sa.gov.au/pehs/publications/public-health-bulletin.htm

Morgan RK (2012) Environmental impact assessment: the state of the art, Impact Assessment andProject Appraisal, 30(1):5-14. doi:10.1080/14615517.2012.661557

Orrell D (2007) The Future of Everything: The science of prediction. Basic Books: New York.

Watts D (2011) Everything Is Obvious (Once you know the answer). Crown Publishing: New York.

Wismar M, Blau J, Ernst K, Figueras J (Eds.) (2007) The Effectiveness of Health Impact Assessment:Scope and limitations of supporting decision-making in Europe, European Observatory on HealthSystems and Policies, World Health Organization: Copenhagen. International Standard BookNumber 978 92 890 7295 3.

Contact information:Ben Harris-RoxasHarris-Roxas Health4/26 Elizabeth StGranville NSW 2142 AustraliaPhone : +61 413679 962E-mail: [email protected]



BACTERIAL AND FUNGAL PROFILE AND ANTIMICROBIAL SUSCEPTIBILITY PATTERN FROM PATIENTS OF CHRONIC SUPPURATIVE OTITIS MEDIA WITH SPECIAL EMPHASIS ON SEASONALVARIATION AT CIVIL HOSPITAL KARACHI PAKISTAN.

INTRODUCTION: Chronic Suppurative Otitis Media (CSOM) is defined as chronic otorrhea for 6-12weeks through a perforated tympanic membrane. The most common organism isolated nowadays arePseudomonas aeruginosa, Staphylococcus aureus, Proteus spp, Klebsiella spp among aerobes whilethe most common fungi are Aspergillus and Candida species. CSOM can cause significant morbidi-ty. The first line of CSOM management is topical antibiotic initiated empirically on the basis of knownbacteriological profile. Following advent and usage of newer synthetic antibiotics there has been a changein resistance patterns of the microbes, therefore knowledge of microbial profile and antibiotic sus-ceptibility pattern is essential to enable efficacious treatment of this disorder.

MATERIALS AND METHODS: The study was conducted from January 2011 to December 2011 atthe department of ENT and Central Lab, Civil Hospital Karachi. A total of 251 patients with unilater-al or bilateral chronic suppurative otitis media attending the outpatient clinic or admitted in the ENTWards were included in this study. Pus samples (Ear swabs) were collected from the discharging ear(s)and sent to Central Lab, Civil Hospital Karachi for Culture and sensitivity test where Aerobic cultureswere done and Antibiotic sensitivity testing was done by Kirby-Bauer disk diffusion technique.

RESULTS: From the clinical specimens of 251 patients, the pathogens were isolated in 206 (82.07�)patients out of which 201 (98�) were bacterial isolates and 5 (2�) were fungi. Pseudomonas aerug-inosa was the most common bacteria isolated in 141 (68.44�), followed by Staphylococcus aureusin 53 (25.72�) cases. Antibiotic sensitivities of Pseudomonas aeruginosa showed that 100� isolateswere sensitive to Carbapenums, where as 97� isolates were sensitive to sparfloxacin and 95� toSulbactam/cefoperazone, piperacillin/tazobactam, 68� were sensitive to aztreonam, 65� to chlo-ramphenicol. For Staphylococcus aureus, 94.3� isolates were sensitive to Fusidic acid, 92� to Linezolidand 90� to vancomycin, 66� to amoxicillin and 60� to ciprofloxacin, ofloxacin.

CONCLUSION: Pseudomonas aeruginosa was the most common isolate followed by Staphylococcusaureus. Clustering of cases was seen during the summer season. More than 80� of Pseudomonasaeruginosa were sensitive to carbapenems and bête-lactamase inhibitors while fusidic acid, vancomycinand linezolid were found to be most sensitive for strains of Staphylococcus aureus. It is therefore con-cluded that the topical preparation of these antibiotics should be incorporated in the course of ther-apy to cover up the most frequent aerobic isolates implicated in CSOM.

Key words: CSOM, Microbiological Profile, Culture and Sensitivity

Contact Information: Dr Ghulam FatimaSenior Pathologist and Incharge Department of MicrobiologyCentral Lab.Civil Hospital, Karachi, Pakistan.Email. [email protected] Ph. Off. ++92-21-99215740 EXT. 5005Cell 03002605992

M.ZEESHAN RAZA1, SYED BILAL1, MARIA SHOAIB1, GHULAM FATIMA2

1: Medical Student, Dow University of Health Sciences, Karachi, Pakistan.2: In-charge, Department of Microbiology, Central Lab, Civil Hospital Karachi, Pakistan.



Estimating the effect of health state on intergenerational poverty in Senegal

Hounkpodote Hilaire Guy AdetonaLaboratory for Research on Social Transformations, Dakar, Republic of Senegal

Introduction: The strong correlation between poverty and health problems is known. However thedynamics of the phenomenon leads to the need for further studies and research to understand thesituation. In this paper, we estimate the effect of health state on intergenerational poverty in Senegal.Data from vulnerabilities and chronic poverty survey in Senegal which is a biographical type surveyconducted by the Laboratory for Research on Social Transformations over the 2008/2009 periodare used. The sample for this survey consists of 1,200 households and 2,400 biographies. This paperaims to introduce the longitudinal approach in the analysis of health and poverty in Senegal.

Methods: When treatment assignment is unconfounded with outcomes conditional on a possibly largeset of covariates, Hirano and Imbens (2001) have proposed a class of estimators of effect based onweighted estimation of the regression function. We use a propensity score weighted regression to esti-mate the health state effect. It is a combination of propensity score matching and weighted OLS regres-sions. The treatment group is the group that the duration of disease is greater than or equal to sixmonths and the control group is the group that duration of disease is less than six months.

Results: The results indicate that the effects are significant for all generations. The duration in thedisease has an effect on well-being approached by the poverty state. In fact, the effect (0.20) is sig-nificant at the 5% level for the older generation (before 1954) and the effect (0.38) is significant at1% level for the younger generation (after 1978), while the effect (0.12 for 1954-1968 generationand 0.14 for the 1969-1978 generation) is significant at the 10% level for the others generations(1954-1968 and 1969-1978).

Discussion and Conclusions: This analysis allows us to conclude that the older and younger gen-erations are much more vulnerable to poverty when the duration of disease is high. The disease hasled to the cessation of activities of individuals. Thus in 28.7%of cases, the disease has led to the ces-sation of professional activity with a suspension of their salaries. Investments in health and raisingthe standard of education must engage one of the largest shares of national and local budgets. Thesocial protection programs should be established as a national priority in order to promote the inclu-sion of vulnerable groups and rehabilitation in development.

Keywords: Health, intergenerational poverty, propensity score weighted

Contact Information: Mr. Hounkpodote Hilaire Guy Adetona Laboratory for Research on Social Transformations (LARTES IFAN)Address: University Cheikh Anta Diop of Dakar (UCAD), BP: 206 Dakar, SenegalZip code: 00221Country: SenegalPhone: +221 77 385 73 00E-mail: [email protected]



Training and capacity building of different implementa-tion models in three Danish local municipalities

Peter Gry1, Mette Winge Fredsgaard1

1: University of Southern Denmark, Esbjerg, Denmark

Introduction: The Healthy Cities Network in Denmark has developed a pilot project on increasing capac-ity building of utilising health impact assessment (HIA) in local and regional organisations. The pur-pose of this project is to develop training material, courses, implementation models, and electronicplatform for exchange of experience and further to test the implementation models in selectedmunicipalities. The focus of this abstract is on the capacity building, training and implementation mod-els.

Methods: This qualitative research consisted of focus group interviews carried out in three munici-palities, who are testing the different implementation models. Interviewees included employees fromthe public health, urban, environment and technical departments. Major questions for the focus groupinterviews included contextual factors such as administrative support, interdisciplinary collaborationand competences within the domain of health determinants. Other main questions included chang-ing mechanism factors such as awareness of health promotion, attitudes towards utility of HIA andmotivation on using HIA.

Results:All interviewees in the municipalities, who participated in training courses, reported a high-er awareness of HIA and its utility after participating in the training courses. Furthermore, all non-health interviewees stated a better understanding of (the determinants of) health and an improvedinterdisciplinary collaboration, especially with the public health department, as a main outcome. Thethree different implementation models had a mixed response in the municipalities. One municipali-ty reported their model as useful because of increased knowledge of other staff’s competences thantheir own and a further development of an integrated health/environment screening. Anothermunicipality described their model as less effective due to undelivered expectation of a trainingcourse and absence of key personal in the implementation process. The last municipality had usedthe implementation model as a launch pad for developing a sustainable strategy and tool in accor-dance with Local Agenda 21 and Aalborg Commitments.

Discussion and Conclusions:The pilot project identified several facilitators and barriers in the imple-mentation models for increasing the utilisation of HIA. Among these were specific course workshopsand both administrative and political support to the project.

Key words: implementation, capacity building, utilization

Contact Information: Mr. Peter GryUniversity of Southern Denmark, Unit for Health Promotion ResearchNiels Bohrs Vej 96700 Esbjerg, DenmarkPhone : +45 6550 4245Fax: : +45 6550 4283E-mail: [email protected]



Impact of electrification on human health – evidencefrom rural Bhutan

Rauniyar, Ganesh P.1

1: Independent Evaluation Department, Asian Development Bank, Manila, Philippines

Abstract

Introduction: The paper examines health impact of the Asian Development Bank’s assistance for ruralelectrification in Bhutan, comprising two loans approved in 1999 ($9.8 million) and 2003 ($12.8 mil-lion). Rural electrification has been attributed to improved indoor air quality and better health out-comes, including reduced incidence of acute respiratory infections. In Bhutan, households still dependheavily on fuelwood for cooking but have started partially switching to the use of electrical appliances.

Methods: In the absence of baseline data, the study adopted propensity score matching method.Propensity scores were estimated for electrified households by a logit regression model that poten-tially affected the outcomes of interest. Household level fixed characteristics, such as age, gender, mar-ital status, religion, education of household head, land ownership, household size, ownership of live-stock type of house, and main source of drinking water were used as the control variables. In addi-tion, a few village level variables such as distance to district headquarters, area and population of thevillage, and availability of educational infrastructure were also used to estimate the propensity scores.The household survey covered 2098 households representing all agro-ecological zones.

Results and Discussion:The study shows that electrification improves health conditions and reducesthe occurrence of health incidences associated with fuelwood and other polluting energy sources suchas candles and kerosene lamps. Members in electrified houses encountered a lower incidence of adversehealth (cough, eye irritation and headache) compared to those in un-electrified households. However,no statistical difference was noted with respect to respiratory ailments. The results are consistent withsimilar studies in other countries at similar level of socioeconomic development. While electricity accesshas provided better lighting of indoors, use of electrical appliances for cooking is limited in rural Bhutanto rice cookers and water boilers. This may be a plausible explanation of no significant impact on res-piratory ailments.

Conclusion: Rural electrification can be attributed to reduced incidence of selected health ailmentsassociated with improved indoor air quality. Efforts are needed to substantially reduce the use of fuel-wood for cooking in rural households with energy efficient electrical appliances.

Key words : impact evaluation, electrification impact on health, indoor air quality

Contact Information: Dr Ganesh P. RauniyarPrincipal Evaluation SpecialistAsian Development BankIndependent Evaluation DepartmentMandaluyong City, Metro Manila 1550PhilippinesTel: +63-2- 632-4593/5039Fax: +63 -2 636-2163Email: [email protected]



Embed Health Impact Assessment into Free TradeNegotiation Processes

Kessomboon Nusaraporn1

1: Faculty of Pharmaceutical Sciences, Khon Kaen University, Thailand

Introduction: There are concerns for the impacts of free trade agreements on people well-being. Manysectors in Thailand then have been calling to have careful consideration on all possible impacts on healthand well-being through the whole processes of developing any free trade agreements (FTA). The pur-pose of this study was to review documents related to free trade negotiation and health impact assess-ment (HIA) in Thailand.

Methods: This documentation research incorporated primary, secondary and tertiary documents. Theprimary sources refer to materials which are written or collected by those who actually witnessed events.The secondary sources are written materials after an event that the author has not personally wit-nessed. Tertiary sources enable researchers to locate other references such as indexes, abstracts andother bibliographies including internet search engines.

Results:HIA in Thailand becoming strongly entrenched within law and policy drawing from the consti-tutional requirement. This constitutional provision motivated the 2007 endorsement of a National HealthAct to establish HIA into national policy, program, project, and also creating a National Health Commissionto prescribe rules and procedure on HIA. In 2010, the Commission issued rules and procedures for HIAin public policies It recommended to conduct HIA for a range of policies, including free trade agree-ments. In addition, the 3rd National Health Assembly in December 2010 recognized the limitations ofmechanisms and processes relating to free trade negotiation on the goods that have impacts on well-being and society and on relevant services; the limitations of integrated operations, participation, con-crete implementation, the application of academic knowledge, and the process to enforce the resolu-tions of the National Health Assembly concerning free trade. Therefore, the assembly resolves the res-olution on “The prevention of the impacts of free trade on well-being and society”. At present, theSecretary-General to the National Health Commission is preparing to organize an issue based healthassembly to consider criteria and methods for HIA in the free trade negotiation processes.

Discussion and Conclusions: This study showed the success of advocacy to ensure that FTA shouldnot be conducted without HIA. In addition, the key to get success in embedding HIA into the free tradenegotiation processes in order to promote the well being of people is the synergy between three sidesof the triangle; a.) knowledge and evidence generation, b.) mobilization of civil society and public sup-port, and c.) the leadership of politicians and policy makers.

Key words : HIA, Freetrade, Negotiation

Contact Information: Assoc Prof Dr Kessomboon Nusaraporn Faculty of Pharmaceutical Sciences, Khon Kaen University,Khon Kaen 40002Thailand Phone : +66-4-336-2090Fax: : +66-4-336-2090E-mail: [email protected]



HIA in ASEAN Community

Suwanakitti Tanita1, Pengkam Somporn1, Kessomboon Nusaraporn2

1: National Health Commission Office, Bangkok, Thailand2: Khon Kean University, Khon Kean, Thailand

Introduction:As for the ASEAN will become One vision One identity One community on 2015, trans-boarder impact must be seriously consider avoiding the impact to people’s well-being. The objec-tive of this study was to review the HIA development in ASEAN Community.

Methods:Data collection based on the secondary data including formal meeting minutes and reports.

Results: The results showed that HIA has been implemented in all ASEAN member states in theform of EHIA. HIA case studies in Lao PDR and Thailand, apart from being a good learningprocess, have proven to be very useful in providing supportive information for EIA reports.Singapore uses HIA for case study. In addition, Vietnam also regulate that HIA must be done forprojects on building industrial zones, cities, health care facilities for infectious patients. Thailand’sapproach uses a public policy process to advocate HIA at the policy level, and at the communitylevel.

Discussion and Conclusions: Therefore, institutionalization of HIA in ASEAN may be consideredby aligning it within the existing ASEAN and other regional platforms.

Key words : HIA, ASEAN, Institution

Contact Information: Ms.Suwanakitti TanitaNational Health Commission OfficeFl.3 National Health Building 88/39 Moo.4 Tiwanon 14 Rd., Talad Khwan, Mueang DistrictNonthaburi 11000ThailandPhone: +66-2-832-9084Fax: +66-2-832-9002E-mail: [email protected]



The Need and Readiness for Health ImpactAssessment of the Organizations in Thailand.

Phen Sukmag1, Pongthep Suteeravut2, Syuwari Morzu2

1: Faculty of Environmental Management, Prince of Songkla University, Songkla, Thailand.2: Health System Management Institute, Prince of Songkla University, Songkhla, Thailand.

Introduction:The National Health Commission Office of Thailand has regulated the procedures of healthimpact assessment (HIA) for healthy public policy in four cases. Firstly, HIA under the Constitution ofThailand the year 2007, Section 67 (2); E-HIA. Secondly, HIA which request by people in accordancewith their right as accorded by section 11 of the National Health Act 2007. Thirdly, HIA in the caseof the development of a public policy and development planning activity. Finally, HIA for learning inthe community; community health impact assessment; CHIA. Therefore, HIA in Thailand has linkedin four main organizations; the government organization, civil society organization, private sector orga-nization and local authority. The objective of this study was in order to examine the need and avail-ability for health impact assessment of the organization in Thailand, in order to develop the buildingcapacity and HIA training in the organization.

Methods: The objective of this study were to explore the need assessment and readiness of HIA infour groups; the government organization, private sector organization, local authority and civil soci-ety organization. The representative of each group was selected by the purposive sample samplingmethod. The study data were collected using participatory observation. One-to-one interviewswere conducted with 63 key informants, all of which were finally analyzed using group discussion andthematic content analysis method.

Results: The results revealed that, the barriers for HIA implementation in Thailand as follow. In thenational level, the legal instruments amended regularly, all the organizations not set HIA policy. Existinglegislation does not support full assessment, including screening and public scoping, public review.The interviewees feedback that most of the organization lack of importance resource; human, tools,financial, HIA knowledge, HIA experience. More than a haft of organization can not support resourcefor HIA.

Discussion and Conclusions: In Thailand, the HIA procedure regulated scoping as public scoping andreview as public review. It is extremely difficult for the assessor and the relevant organization to con-duct HIA because lack of public scoping tools and pubic review tools. The results of this study we takenfor HIA training in Thailand.

Keywords: HIA Need assessment, HIA traning and building capacity

Contact Information: Miss Phen SukmagFaculty of Environmental Management, Prince of Songkla University, Hatyai Campus, Hatyai, Songkla, 90112, Thailand.Phone : +66-8-959-51811E-mail: [email protected]



Community Based Project Management: a PromisingApproach for Alleviating Sub Standard Neighborhoodin IndonesiaAsnawi Manaf1

1: Urban and Regional Planning Department, Diponegoro University, Semarang, Indonesia

Introduction: In recent decade, the Indonesia's housing policies are marked by the continuousdecrease of the state’s role in ensuring the fulfilment of the people housing needs. These quasi "lais-sez faire-policies" lead, however, to unfair distribution of social goods in the society including in thehousing sector. To respond the weakness of this policy, the Indonesian state ministry for people hous-ing gives more attention on the so called community based approaches. Recently, the governmentintroduces a program called community based sub standard neighborhood improvement (in bahasa:Program Peningkatan Kualitas Perumahan).

Methods: This article aims at describing a case study research result on the implementation of thePKP Program in Pringapus Village, Semarang District, Indonesia. The research was conducted from2009-2010. The qualitative research method (‘participatory action research’) had been employed,where the researcher was also partly involved in the implementation process as an observer.

Results: In case of the PKP Project implemented in the Pringapus Village it shows that there is“measurable” success story in dealing with the housing problem for the poor. However, to make it moresustainable, it is necessary to integrate PKP project which is only clustered in the neighborhood levelwith the development plan in the city-wide level. Besides, good social capital in the area is the pre-requisite of the success of the program. The role of local voluntary organization (BKM) is also one ofdetermining factors for the success. In practice, BKM can organize and mobilize the social resourcesand local know-how to support the implementation of the project.

Discussion and Conclusions: This paper concluded that community based project managementapproach can increase transparency and accountability in determining the “real” target group (ben-eficiaries) and mobilizing of the social resources available in the community to support the project sothat the project can be accomplished with high added value of output.

Keywords: community based project management, local voluntary organization, and sub standard neigh-borhood improvement program.

Contact Information: Dr. –Ing. Asnawi ManafUrban and Regional Planning Department, Diponegoro University,Jl. Prof. Sudharto, SH. Tembalang, Semarang, 50271, IndonesiaPhone : +62 24 7460054Fax: : +62 24 7460054E-mail: [email protected] or [email protected]



Health Impact Assessment, a process of harnessingwisdom or squeezing in data?

Domyung Paek, Seoul National University

HIA is to provide recommendations for public policy based on scientific discipline. Hopefully, it shouldbe an approach to apply a wisdom garnered through scientific work to areas that need another wis-dom. However, in reality, it tends to be an approach to squeeze a few data collected in haphazard wayto unexplored possibilities. This is especially true in countries with very few its own database.

Here in this presentation, I will explain about the differences between data, information, knowledge,and wisdom, and the way to get wisdom starting from data. In this fashion, wisdom cannot be deriveddirectly from data itself.

I will also present the global situation of asbestos ban. Even though asbestos hazard is so widely known,less than 50% of those countries that have used asbestos have banned its further use. As forasbestos, the most intensely studied hazardous material, health impact assessment should have yield-ed the same recommendation, but in fact it haven’t. I will explore why.

In the last summary, I will try come up with a few essential elements of HIA to have any meaning inthose countries with so little experiences.

Keywords: Data and Wisdom, Asbestos Ban, Validation, Evaluation, Participation

Contact Information: Domyung Paek, MD, MSc, ScDProfessor, Occupational and Environmental MedicineSchool of Public Health, Seoul National University1 Gwanak-ro, Gwanak-gu, Seoul 151-742, Korea☎(T): +82+2+880-2733 ☏(F): +82+2+743-8240☞[email protected] ☞http://www.health21.or.kr



Application of Exposure Science and Risk Assessmentin HIA

Kiyoung Lee1

1: Seoul National University, Seoul, Korea

Introduction: Health impact assessment (HIA) can be defined in many different manners. Generallyspeaking, HIA can be described as approach to help identify and consider the potential health impactsof a proposal on a given population. The primary purpose is to provide evidence-based recommen-dations for the decision-making process. The recommendation of HIA can highlight practical waysto enhance positive impacts and remove or minimize negative impacts on health that might arise.

Exposure and Risk Assessment:Exposure science can apply direct measurement and indirect esti-mation to determine exposure. Direct measurement can often provide better estimation of popula-tion exposure, although it requires more resources and time. However, direct measurement is not applic-able in HIA, because HIA is to consider potential health impact of a non-existing circumstances. Exposureand risk assessment in HIA may be limited to indirect estimation.

Application of Exposure and Risk Assessment in HIA:Results of indirect estimation of exposure andrisk can be affected by level of input data. For a proposal, input information can be simple estimationwith high uncertainty. Unlike existing exposure, the most HIA process should be based on best avail-able evidence and estimation. Indirect exposure assessment in HIA can be classified into quantita-tive and qualitative approaches. In exposure science and risk assessment, quantitative approach isalways preferred to qualitative approach. However, selection of quantitative and qualitative estima-tion is up to the purpose of HIA. It should be noted that HIA is to inform decision-maker the best avail-able evidence.

Discussion and Conclusions:HIA in Korea is still under development. However, its need is obvious forprotecting population from potential health impacts of a proposal. It is clear that HIA should be on-going process to develop further whenever new and clear evidence is emerged.

Keyworkds : Qualitative, Quantitative, Model. Exposure estimation

Contact Information: Dr. Kiyoung LeeSeoul National UniversityGraduate School of Public Health 1 Gwanak-ro Gwanak-gu, Seoul, 151-742 KoreaPhone : +82-2-880-2735Fax: : +82-2-762-2888E-mail: [email protected]



Is HIA Effective for Top Level Administrative Plan?

Young Soo Lee1

1: Korea Environment Institute, Seoul, Korea

Introduction:HIA in EIA started in 2010 in Korea and target project of HIA was restricted to severalbig projects like industrial complex construction, power plant construction. From 2010, many HIA havebeen carried out in EIA process and HIA in EIA was considered to be valid. On the other hand, we wouldlike to confirm feasibility of HIA for top level administrative plan in order to enlarge target of HIA. Sowe accomplished HIA on industrial complex supply plan, the top level administrative plan for indus-trial complex development.

Methods:We analyzed the contents of 2nd industrial complex supply plan (2002~2011) and executedscreening, scoping, appraisal, making recommendation and monitoring plan.

Results: Because of lack of information in detail, it is very difficult to analyze impact on health quan-titatively. So, qualitative recommendation was given.

Discussion and Conclusions:The recommendation for industrial complex supply plan is that prepa-ration of a few executive plans is necessary when lower level plan for industrial complex developmentis set up. 1st, there is a need to prepare a plan for enhancement of worker’s health. 2nd, adoption ofconcept of eco industrial park in industrial complex supply plan is needed to consider environmentalpollution, health of people living near industrial complex. 3rd, sustainable plan is needed to consid-er environment, nature, civilian, job and cooperation with local community. The problem is that thisrecommendation is ambiguous and that kind of recommendation can be made without HIA.

Key words : HIA, Industrial complex supply plan,

Contact Information: Dr. Young Soo LeeKorea Environment Institute Jinhungro 290, Bulgwang-dong, Eunpyeong-gu, Seoul, 122-706, KoreaPhone : +82-2-380-7657Fax: : +82-2-380-7744E-mail: [email protected]



HIA on Dam Construction in Korea

Young Soo Lee1

1: Korea Environment Institute, Seoul, Korea

Introduction:HIA in EIA started in 2010 in Korea, although, dam construction is not the target pro-ject of HIA. Dam gives lots of adverse impact on health as well as environment. For example, fog formedby increase of water body reduces sun light and agricultural product. And if there are mines at theupstream of dam, the pollutants like heavy metals concentrated in dam and, therefore, water pollu-tion is expected. So, there is need of HIA implementation on dam construction. We had HIA onmulti-purpose dam of which several mines exist at the upstream to confirm the effect of heavy metalon health of people using the water inside the dam.

Methods: We calculated the concentration of heavy metals in water body with mathematical equa-tion and compared it with national standards for protection of human health in order to confirm theimpact on health. Besides that, we examined the change of fog formation day and the impact causedby fog formation.

Results: There is no adverse impact from heavy metals leached out by water mines. The number offog formation day increased by 8 days and illumination time decreased by 32 hours within water reser-voir areas.

Discussion and Conclusions:Because there is no strong evidence for fog-health relation, it is not surethe dam gives bad impact on human health. Furthermore, because there is no effective measures toreduce harmful effect after dam construction, sincere monitoring for weather change, agricultural prod-uct amount, and health of residents is recommended.

Key words : HIA, Dam construction, Mineral mines, number of fog formation day

Contact Information: Dr. Young Soo LeeKorea Environment Institute Jinhungro 290, Bulgwang-dong, Eunpyeong-gu, Seoul, 122-706, KoreaPhone : +82-2-380-7657Fax: : +82-2-380-7744E-mail: [email protected]



Health Impact Assessment in Healthy Cities in Korea

Dongjin Kim1

1: Korea Institute for Health and Social Affairs, Seoul, Korea

Introduction:WHO identified “healthy public policy” as one of the five key elements in promoting healthin the Ottawa Charter. A healthy public policy refers to a policy that seeks to promote health of indi-viduals or local communities affected by the policy and to improve equity in health. Health impact assess-ment can become the most appropriate means of implementing healthy public policies.

Methods:Health impact assessment targeting healthy cities projects was undertaken to build healthpublic policies at local government level from 2009 in Korea. The health impact assessment projectsbegan by inviting the local governments of the Healthy Cities Partnership that wished to participatein the projects. The projects were immediately carried out using detailed tasks and timelines deter-mined in discussions with project officers of each local government.

Results:A total of 14 health impact assessment projects were conducted for 3 years between 2009and 2011, on a wide range of areas including residential environment, sport facilities and park cre-ation, transportation, and air pollution. Health impact assessment in healthy cities defines health broad-ly and comprehensively to include physical, mental and social well-being, and takes into account var-ious types of determinants of health, including social and physical environments of local communi-ties. Also, health impact assessment brings health and equity into the center of all policy, project orprogram considerations for all sectors including health.

Discussion and Conclusions:Following benefits can be expected by introducing health impact assess-ment in the course of implementing a healthy city: First, health impact assessment provides a morecomprehensive set of information that can be used as the basis for decision-making and priority-set-ting. Second, once decisions are made, health impact assessment enables decision-makers to bet-ter respond to health problems. Third, decision-makers are made aware of health as an importantaspect of sustainable development. Fourth, health impact assessment helps bring attention to the healthand well-being of local residents. Fifth, health impact assessment provides an opportunity to learnand advance the process of improving health in a wide range of sectors, not just in the health or healthdeterminants sector. Sixth, health impact assessment makes it possible to utilize resources before prob-lems occur, not after problems occur.

Keywords : Health Impact Assessment, Healthy City, Determinant of Health, Healthy Environment

Contact Information: Dongjin KimAssociate Research FellowKorea Institute for Health and Social AffairsJinhungro 268, Bulgwang-dong, Eunpyeong-gu, Seoul, 122-705 KoreaPhone : +82-2-380-8278Fax: : +82-2-353-0344E-mail: [email protected]



Using community knowledge in promoting health:Examples from two case studies in Seoul

Jinhee Kim, Seunghyun Yoo

Graduate School of Public Health, Seoul National University, Seoul, Korea

Introduction:Traditionally, policies and programs to promote community health are developed fromevidence produced by ‘outside experts’. This approach may lead to insufficient responses to the com-munity’s actual concerns. By reviewing cases of two studies recently conducted in Seoul, this paperemphasizes the role of community knowledge as valid evidence for health promotion.

Methods: In the first case, 12 citizens were asked to unveil the meaning of walking in the city and itsfacilitating factors and barriers through a participatory process called ‘photovoice’. In the second case,17 teenage students were interviewed in focus groups to explore factors associated with bicycling toschool.

Results: In the first case, walking was regarded not only as a physical activity, but a very importantactivity for mental and psychosocial health for urban residents. Social environments conducive forwalking, such as assimilation with the surroundings, feeling of ease and relaxation, friends and fam-ily to accompany, were considered to be as important as the physical environments such as accessto walking-friendly street design. Barriers include factors related with street infrastructure such aslack of walkable streets and poor street design, with emphasis on obstructive behavior incurred bypoor sense of citizenship. The second case revealed that contextual factors such as the location ofthe school and availability of easier alternative methods (walking, bus, etc.) would determine students’bicycle riding to school. Moreover, students were not aware of safety measures or traffic regulationsassociated with bicycle riding and had almost no prior bicycle safety education. Promoting safety wouldbe a prerequisite for the local health department to increase physical activity through promoting bicy-cle use. These insights are the ‘community knowledge’ that is produced from the context of every-day experiences of community members.

Discussion and Conclusions: Community knowledge from these two case studies explicitly show thatthe community’s concerns for walking and bicycling go beyond the scope of the local health depart-ment’s objectives for promoting physical activity. While positivist research paradigms argue that knowl-edge creation is a neutral and value-free activity, it is only through the experience of the communi-ty itself that valuable evidence can be created. Community knowledge provide the evidence-basedrecommendations to develop, influence or modify a policy or project in order to maximize health gainand minimize negative outcomes.

Keywords : Community knowledge, Participatory research, Physical activity

Contact Information: Ms. Jinhee KimSeoul National University Graduate School of Public Health1 Gwanak-ro, Gwanak-gu, Seoul 151-742, KoreaPhone : +82-2-880-2751Fax: : +82-2-745-9104E-mail: [email protected]



The potential health effects of climate change on the elderly population in Korea

Yoon Shin Kim, Sung Won Yoon, Hyung In Jeon, Cheol Min Lee, and Joung Won Lee

Institute of Environmental & Occupational Medicine, Hanyang University Seoul, Korea (E-mail: [email protected])

Introduction:Weather-related health concerns have recently been issued in Korea because of the glob-ally observed relationship between climate conditions and mortality changes in general populationgroup. Most of studies focus on an investigation of epidemiological and physiological evidence aboutthe range of health effects associated with hot weather, whereas research activities of relationshipbetween cold weather and heath of the vulnerable population group have been rather limited.Especially, it has been proven that cold temperature or cold wave which is one of the key factors inclimate change event, has potential implications for the health of the elderly people. Although the agedpopulation in Korea rapidly increases, the relationship between climate change and their healtheffects have not been well identified.

Method:We investigated the effects of winter temperature in Seoul, Korea on mortality of the elder-ly population (ages 65+) during 1992-2007. To do this, we collected climate and death records datafrom the Korea Statistics Agency and Korea Meteorological Center for the years 1992 through2007. The study also estimated the future risks by employing the projections of the population in Seoul,Korea and climate change scenario of Korea from 2011 to 2030.

Results: There appeared to be significant increases in mortality of 0.27% of total deaths, 0.52% ofrespiratory disease, and 0.32%of cardiovascular disease, respectively, with decreasing of 1˚C in dailyminimum temperature based on past record.

Discussion and Conclusions:The limitation of this study was the impossibility in the prediction of dailymortality counts. Therefore, daily death numbers could be predicted based on the future populationprojection for Korea and the death records of 2005. Based on the results, cold weather effect on healthresulted from the climate was found to be significant. We concluded that the risk of mortality will increasedespite of an associated uncertainty in estimation of death counts. The details on differential effectsof climate change on sensitive populations including children and the aged population, and appro-priate prevention and policy advocacy will be discussed at the presentation.

Keyworkds : climate changes, mortality, elderly people

Contact Information: Dr. Yoon Shin Kim, , MPH, DrHSC, PhDProf. & Dirctor, Institute of Aging Society Institute of Environmental & Occupational MedicineHanyang University, Seoul, KoreaInstitute of Environmental and Industrial Medicine, Hanyang University, Seoul KoreaPhone : 82-2-2220-0692/ +82-2-2220-4041E-mail: [email protected] (O)/ [email protected] (Personal)



Health Impact Assessment of Settlement Re-devel-opement: A Case from Low-income Area of Small Cityin South Korea

Kwang Wook Koh1, Young Hyun Shin1, Jae Rak Ahn2, Young Sim Yun3

1: Kosin University, Busan, Korea, 2: Gyeongsang University, Jinju, Korea, 3: Urban Space Design Institute. Co., Ltd, Changwon, Korea

Introduction:The rapid “compressed” urbanization of South Korea is unprecedented and “re-devel-opment of urban old village” has been is recent sociopolitical agenda in south Korea cities and havesome notorious side effects. The purpose of this study was to know the subjective effects of old hous-ing and village environment of Gangnam-dong in Jinju city, for minimizing the negative effect andmaximizing the positive effect of “temporary house rotating re-developement of housing in low incomevillage of medium sized city.

Methods: Based on The Health Impact Assessment Guideline for Housing Environment Improvementof Korean Institute for Health and Social Affairs and A Practical Guide for Health Impact Assessmentof New South Wales of Australia, literature review, various meetings(brain-storming, screening,consulting and workshop) held in 2010. In addition to village inhabitant, people from Department ofplanning, Public health center, Inhabitant self-regulation center participated. Health and urban plan-ning professional from near regional university and organization including YMCA also participated

Results: In physical aspect, contamination of environment from wastes, bugs and traffic and sewageraised first as problem. In social aspect, no meeting place for elderly, passenger safety and illegal park-ing of cars in narrow street, insufficient lighting and crowding caused frequent quarrel among neigh-bor and crime. In human health aspect, wide road obstructs the crossing to the river-side green areaand too big train noise in misty day cause stress, sparse outing due to dirty narrow alley cause phys-ical inactivity and social isolation. Some unreasonableness and irrationality found in view of inhabi-tants including housing repair cost and minimal area requirement for compensation of small land. Positiveeffect derived about temporary house rotating re-developement of housing in low income village wereminimizing the destruction of existing infra, new employment, new open space and resettlement ofinhabitants. Negative effect derived was apprehension about external support

Discussion and Conclusions: Inhabitants need clearly about community based improvement includ-ing hygiene, lighting and car parking etc. Specific policy and methods needs more refinement basedon community participation and empowerment. Temporary house rotating re-developement ofhousing in low income village found to have many positive effect and some negative effect in view ofinhabitants

Keywords : re-developement, settlement, housing

Contact Information: Professor Kwang Wook KohKosin University34, Amnam-dong, Seo-gu, Busan, 602-703 KoreaPhone : +82-51-990-6426Fax: : +82-51-990-3036E-mail: [email protected]



The Experience of Health Impact assessment ofImmunization Program in Jinju City, Korea

Keon Yeop Kim1 So Youn Jeon2 Man Joong Jeon3 Kwon Ho Lee4 Sok Goo Lee5 Dongjin Kim6 EunjeongKang7 Sang Geun Bae1 JinHee Kim8

1: Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu, Korea 2:Department of Emergency MedicalTechnology, Daejeon Health Sciences College, Daejeon 3:Department of Preventive Medicine and Public Health, Yeungnam University Collegeof Medicine, Daegu 4:Department of Satellite Geoinformatic Engineering, Kyungil University, Gyeongsan 5:Department of Preventive Medicine,Chungnam National University School of Medicine, Daejeon 6:Division for Health Promotion Research, Korea Institute for Health and SocialAffairs, Seoul 7:Department of Health Administration and Management, Soonchunhyang University, Asan 8:Institute of Health Science, KoreaUniversity College of Health Science, Seoul, Korea

Introduction: The Jinju City in Korea launched free immunization program to remove geographicaland economic barriers to childhood immunization. The purpose of this study was to assess thepotential health impacts and improve the quality of the free immunization pro-gram in Jinju City bymaximizing the predicted positive health gains and minimizing the negative health risks.

Methods: A steering committee was established in September 2010 to carry out the health impactassessment (HIA) and began the screening and scoping stages. In the appraisal stage, analysis of sec-ondary data, literature review, case studies, geographic informa¬tion systems analysis, a question-naire, and expert consultations were used. The results of the data collection and analyses weredis¬cussed during a workshop, after which recommendations were finalized in a written report.

Results: Increased access to immunization, comprehensive services provided by physicians, thestrengthened role of the public health center in increasing immunization rates and services, and theripple effect to other neighboring communities were identified as po¬tential positive impacts. On theother hand, the program might be inaccessible to rural regions with no private clinics where there aremore at-risk children, vaccine management and quality control at the clinics may be poor, and vac-cines may be misused. Recommen¬dations to maximize health gains and minimize risks were sep-arately developed for the public health center and private clinics.

Potential impact on health Recommendations

PositiveIncreased access to immunizationIncreased immunization rateDelivery of comprehensive health service at private clinicsStrengthened role of the public health center in increasingthe immunization rate and service coordinationContribute to the national policy to reverse the low-birthrate phenomenaRipple effect to neighboring communities

NegativeIncreased access limited to only some regions within JinjuCityPossibility of poor management of vaccinesLow quality of health professionalsMisuse of vaccines

Recommendations to public health centerReorient the role of the public health center for immuniza-tion and develop administrative preparationsDevelop strategies to increase booster immunization ratesIdentify and include marginalized communities and popula-tion groupsPrevent budget cuts in other welfare programsExpand program to include elective immunization policyEstablish a monitoring system for program evaluationCollaborate with other relevant sectors

Recommendations to private hospitals and clinicsImprove management of vaccinesProvide training for health professionals and strengthenquality control measuresDevelop a strategy in case of vaccine shortageInclude comprehensive health checkup servicePromote parents’ awareness of the elective immunizationpolicy



Discussion and Conclusions: The HIA provided an opportunity for stakeholders to comprehensive-ly overview the potential positive and negative im¬pacts of the program before it was implemented.An HIA is a powerful tool that should be used when developing and implementing diverse health-relat-ed policies and programs in the community.

Keywords: Free immunization programs, GIS analysis

Contact Information: Dr. Keon Yeop KimDepartment of Preventive Medicine, Kyungpook National University School of Medicine 101 Dongin 2, Jung-Gu, Daegu, Korea 700-422 Phone: +82-53-420-4863Fax: +82-53-425-2447E-mail: [email protected]



The Impact of Socioeconomic Environment on LocalSuicide Mortality: Evidence from a Spatial Analysis

Eunjeong Kang1, Hosung Shin2

1: Soon Chun Hyang University, Asan, Korea; 2: Won Gwang University, Iksan, Korea

Introduction: Suicide mortality of Korea was 31 per 100,000 in 2009 and it has been the highest amongthe OECD countries since 2007. Within the country, a wide variation in suicide morality has been observed.The purpose of this study was to find out how socioeconomic environment factors are related to localsuicide mortality using a spatial analysis.

Methods:Age-standardized suicide mortality of 253 local government areas was obtained from theNational Statistics Office. Variables indicating socioeconomic environment of each local area includ-ed percentages of high school graduates, population density, number of beds per 1,000, percent-ages of single-parent households, percentages of rented housing, number of rooms per householdmember, percentages of moving population, percentages of singles, divorce rate(%), percentages offarmers, and percentages of population with chronic diseases. All data were of year 2010 andobtained from the NSO. Geographical distributions of suicide mortality by sex were obtained using ArcGIS.The existence of spatial correlations was tested using Moran’s I test. To analyze the relationship betweenlocal suicide mortality and socioeconomic environment spatial analysis was used to consider the sig-nificant spatial relations among local areas.

Results:The local suicide mortality of total population was negatively related to percentages of highschool graduates, population density and positively related to percentages of single-parent house-holds, percentages of rented housing, number of rooms per household member, divorce rate, and num-ber of chronic diseases. The local suicide mortality of males was negatively related to population den-sity and positively related to percentages of sing-parent households, number of rooms per house-hold member, divorce rate, and number of chronic diseases. The local suicide mortality of females wasnegatively related to percentages of singles and positively related to percentages of rented housings,number of rooms per household member, and divorce rate.

Discussion and Conclusions:Several socioeconomic environment factors were found significantly relat-ed to local suicide mortality even after controlling geographical correlations.

Keyworkds : suicide mortality, spatial analysis, socioeconomic environment

Contact Information: Dr. Eunjeong KangDepartment of Health Administration and ManagementSoon Chun Hyang University22 Soon Chun Hyang Ro, Shinchang-Myeon, Asan, 336-745 KoreaPhone : +82-41-530-1391Fax: : +82-41-530-3085E-mail: [email protected]



Association of Part-Time Work and Suicide Attemptsamong Korean Adolescent Students: a National Cross-Sectional Survey

Sun-Jin Jo1, 2 , Hyeon Woo Yim1, 2, Myung-Soo Lee3, Hyunsuk Jeong1, 2, Won-Chul Lee1

1: Department of Preventive Medicine, College of Medicine, the Catholic University of Korea, Seoul, Korea2: The Clinical Research Center for Depression of Korea, Seoul, Korea3:Seoul Suicide Prevention Center, Seoul, Korea

Introduction:According to a recent meta-analysis study, occupation or employment status increas-es the risk of suicide in adults. However, there exist few studies investigating the association betweenin-school students’ part-time work and suicide attempts.

Methods:This study analyzed Korean Youth Risk Behavior Surveillance data (2008) including 75,238samples that represent Korean middle and high school students. Logistic regression analysis was per-formed to investigate the association of part-time work and suicide attempt during past 1 year con-trolled by socio-demographic, school-related, life-style, and psychological factors.

Results: There was no association between part-time work and suicide attempt after socio-demo-graphic, school-related, life-style, and psychological factors were controlled among high schoolstudents. But as to middle school students, part-time work was associated with suicide attempt sig-nificantly. (OR=1.59, 95% CI: 1.37-1.83)

Discussion and Conclusions:Middle school students’ part-time work may increase their suicide attemptin Korea. It is suggested that social and legal environments related with adolescents’ labor need tobe reviewed for prevention of their suicide attempt.

Key words : Adolescent, Work, Suicide

Contact Information: Dr. Sun-Jin JoDepartment of Preventive Medicine, College of Medicine, the Catholic University of Korea505 Banpo-dong, Seocho-gu, Seoul, 137-040 KoreaPhone : +82-2-2258-7366Fax: : +82-2-532-3820E-mail: [email protected]



Health Impact Assessment Capacity Development inVietnam

Nguyen T.L.H1, Ton T.N2

1: Health Environment Management Agency, Ministry of Health, Vietnam2: World Health Organization Representative Office in Vietnam, Hanoi, Vietnam

Introduction: In the period of 2005 - 2009, the “Health Environment Management Agency” (HEMA)of the Ministry of Health, together with partners of the World Health Organization (WHO) and the CapacityBuilding International, Germany (InWEnt), the DBL – Centre for Health Research and Development ofthe Faculty of Life Sciences, University of Copenhagen (Denmark) were engaged in intersectoral HealthImpact Assessment (HIA) capacity building in Vietnam. Since 2009, HEMA in co-operation withWHO and Ministry of Natural Resources and Environment (MoNRE) has continued to conduct capac-ity building in HIA and step by step set up a foundation for development of HIA process in Vietnamthrough the proposal of National Environmental Health Action Plan (NEHAP). However, a lot ofefforts and commitment from related stakeholders are needed to insitutionalize HIA process.

Methods:A literature review method was used. A discussion with partners (WHO, MoNRE) was con-ducted to get an overview of the whole process of HIA development in Vietnam.

Results: In retrospect the activities have included:

1) A “National Workshop on Health Impact Assessment” addressing HIA principles and practicefor a target group of Ministry of Health staff (Do Son, October 2005);

2) A “Workshop on Development of a Training of Trainers Course Curriculum on HIA” (Hanoi,November 2006);

3) A “Course on Training-of-trainers for HIA Capacity Building” (Da Nang, Sept. 2007);

4) A Technical Briefing Workshop on Health Impact Assessment, (Hanoi, November 2007).

5) A Joint HIA Orientation and Refresher Course (Ha Long, May 2008).

6) A pilot HIA training course at provincial level (Ba Ria Vung Tau, October 2008).

7) A training material of HIA developed for provincial health and environment staff (Ha Noi,September 2011)

8) HIA issues were discussed and put into the draft proposal of NEHAP during technical workinggroup meetings (2010, 2011)



9) Two Training courses on HIA for provincial health and environment staff (Nha Trang, October2011 and Quang Ninh, November 2011).

10) A Guideline on HIA for development projects has been under development by HEMA with WHOsupport.

Discussion and conclusions: Through a series of training activities in the capacity building for HIA,a pool of key trainers in HIA including focal staff in MoH and MoNRE has been established to servefor further trainings at national and provincial levels. Awareness on HIA in healthcare and environ-mental staff at all levels has been improved. There have been co-operation between MoH andMoNRE in developing NEHAP. However, all those efforts seem to be not enough to facilitate insitu-tionalization of HIA process. Building HIA process requires not only efforts, commitments and patiencebut also an appropriate approach and a long vision.

Key words: HIA, capacity building, Vietnam

Contact Information: Nguyen Thi Lien HuongGeneral Deputy Director of Health Environment Management Agency, Ministry of HealthAlley 135 Nui Truc, Ba Dinh district, Ha Noi city, VietnamPhone: +84 4 37368392Fax: +84 4 37368394Email: [email protected]



P.R.Prak1, S.Kong2, E.M Khoung3

1 Director Preventive Medicine, Ministry of Health, Cambodia; 2 Calmette Hospital, Phnom Penh, Cambodia; 3 Deputy director PreventiveMedicine, Ministry of Health, Cambodia

MultisectOral PARTICIPATORY APPROACH FORHEALTH IMPACT ASSESSMENT IN CAMBODIA

OVERVIEW

•Increase urbanization - plan to respond to changing lifestyles•Increase in environmental risk factors - air, water and soil contamination as well as other riskfactors associated with the built environment

•Process of socio-economic development – use naturaland human resources to serve for thedevelopment

•The impact both to health and discharged pollution and hazardous waste to the environment•These factors are contributing to an increase in both communicable diseases, non-commu-nicable diseases and injuries, poor nutrition and mental ill-health

•Emerging environmental health issues - global climate change presents new challenges•Threats of serious or irreversible damage to the environment•HIA offers a practical and flexible framework for identifying health and equity impacts and waysof addressing them

PRIORITY INTERVENTION

•Effective establishment of inter-sectoral and inter-disciplinary working group•Implement measures that ensure public participation in the HIA process including full accessto relevant information

•Optimal openness and great proclivity to participation by the communities involved•Apply screening criteria to the policy, program, project or plan. Determine whether an HIA isrequired

Selected developmental projects that

required EIA & HIA :- constructing tower/new city, - coal power/ hydropower/fuel power plant, - mine - heavy industries, biogas plant- hazardous waste incineration plant, - agriculture and plantation



HEALTH ISSUES NEED TO BE ADDRESSED

Construction•Health of workers and communities from construction work especially dust, noise, traffic•Disease surveillance established for injuries, respiratory diseases, vector and water borne dis-eases

Operation•Potential pollutants associated with discharges from the plant to the air, water and soil•Disease under surveillance are cancer, congenital deformities, respiratory diseases, skin dis-eases etc.

•Social and welfare of the workers

Challenges

•Socio-economic growth within Cambodia can have both positive and negative impacts on theenvironmental and social determinants of health

•RGC not realize as priority issue•Difficulties in agreement dialogue, decision-making and resolving conflicts among differentpartners in the process

•Extremely high degree of socio-political health and environmental complexity•The procedures of the EIA is not include HIA •HIA policy still in the process of approval by the National Committee for Environmental health•Neediness capacity on HIA among health professionals

WAY FORWARDS

•Advocacy for political commitment• Institutional arrangements•Select the appropriate assessor and appraisal of HIA statement•Institutional regulation and compliance of the HIA process•Inter-sectoral capacity building of government and non government HIA regulators and prac-titioners

•Public participation in the HIA process including full access to relevant information•Negotiation with final choice of options for health risk management •Ongoing inter-sectoral capacity building of government and non government HIA regulatorsand practitioners is seen as strategically important

•Encourage and assist as required the development of an association of HIA professionals with-in the country to further enhance capacity building.

•Implement measures that ensure public participation in the HIA process including full accessto relevant information.

•Ensure wider reaching collaboration of HIA practitioners within the region

Contact Information: Dr. Prak Piseth RaingseyDirectorPreventive Medicine departmentMinistry of Health#151-153, Blvd. Kampuchea Krom,Phnom Penh, CambodiaPhone : (855)12862022email: [email protected]



Determination of Environmental Factors thatInfluenced Cholera Outbreak in Catanduanes Province,Philippines

Maria Sonabel S. Anarna1

1: Department of Health, Philippines

Introduction:On June 2012, the Department of Health (DOH) declared a province-wide outbreak ofcholera in Catanduanes, Philippines. The outbreak resulted in 2,021 cholera cases and 14 validat-ed fatalities according to the Catanduanes Health Update No.17 as of 10 July 2012. Catanduanes isthe 12th largest island in the Philippine Archipelago occupying an area of 1,511.5 square kilome-ters and the smallest among the six provinces that constitute the Bicol Region. With the DOH out-break declaration, the DOH & WHO Philippines formed a mission team that included the Local WaterUtility Authority (LWUA). The purpose of the mission was to determine the environmental factors thatinfluence the cholera-stricken health condition of the populations of the province. The investigationfocused on the aspects of water, sanitation and hygiene (WASH).

Methodology: The assessment comprises of the following activities in the field: site visits of five barangaysin two municipalities of Catanduanes, interview with the households and local leaders, and review oflocal reports. During the site visit, the water supply and sanitation systems used by the populationswere given emphasis. For the one-on-one interview with the respondents, key questions wereasked on their hygiene practices and health-seeking behavior.

Results: The findings of the assessment endeavor identified the following factors that could have influ-enced the cholera outbreak of the province: open defecation practices, absence of chlorination in watersystems, poor water source protection, absence of regular water quality monitoring, uncontrolled dis-posal of garbage and wastes from backyard piggery and poultry, and the location of affected areaswherein several confirmed cholera cases were along the rivers and shorelines with high populationdensity.

Discussion and Conclusions: There were times during the outbreak that diarrheal cases in theaffected areas were decreasing in its trend, but there is no assurance that the upsurge in cases maynot happen again unless the identified risk factors are given preferential attention for intervention.

Keywords : cholera, environmental factors

Contact Information: Engr. Maria Sonabel S. AnarnaDepartment of HealthSan Lazaro Compound, Sta. Cruz, ManilaPhilippinesE-mail: [email protected]: Mission Report on the Cholera Outbreak Assessment for water, sanitation and hygiene con-ducted on July 2012 by the mission team- Bonifacio Magtibay (WHO Philippines), Maria Sonabel S.Anarna (DOH), Virgilio Bombeta, Edison Cuenca, and Arturo Fernando (LWUA).



Health Impact Assessment in Mongolia

Tsetsegsaikhan Batmunkh

Ministry of Health, Ulaanbaatar, Mongolia

Introduction:Mongolia is currently going through a period of increased economic activity with therecent unveiling of some of the largest mineral deposits in the world. The growth of financial mar-kets is accompanying the rapid development in the mining industry and agriculture. The incorpora-tion of Health Impact Assessment (HIA) with the current existing Environmental Impact Assessment(EIA) will be important in protecting the health of the population during this period of economic growth.

Results: Mongolia established EIA legislation and the processes regulating this assessment in the Lawon EIA from 1998. The Law was renewed in 2012 and particularly new issues, such as strategic impactassessment and health impact assessment were included. The Law states that the “Procedures onconducting an examination on Detailed Environmental Assessment” need to be approved byGovernment Resolution, taking into account health and social impacts.

Conclusion: Legal integration of HIA within the current EIA process will provide an effective mech-anism for establishing comprehensive HIA structures and avoiding health impacts in the early stagesof project development. To implement best practice HIA there is an urgent need for capacity build-ing amongst health sector professionals, developing appropriate detailed guidance on the ways toconduct assessment.

Key words: health impact assessment, environmental impact assessment

Contact Information: Tsetsegsaikhan BatmunkhPublic health policy coordination and implementation departmentMinistry of Health Government building VIII, Olympic street-2Ulaanbaatar, MongoliaPhone: 976-51-263925E-mail: [email protected], [email protected]



Health in EIA : Thailand’s Experiences

Siriwan Chandanachulaka.

Siriwan Chandanachulaka. Health Impact Assessment Division, Department of Health, Ministry of Public Health, THAILAND

Introduction: Environmental Impact Assessment system in Thailand had launched since 1981 about31 years ago, as a part of permit approval. It is responsible by the Ministry of Natural Resources andEnvironment. It has been changed in terms of regulation, number of projects that shall conduct EIA,consideration procedure and support system. Types of project/activity to conduct EIA had increasedfrom 10 to 34 types of projects/activities with 11 special types of projects that have to conduct envi-ronment and health impact. However, it seems that health in the EIA is not well assessed and stat-ed. This project aims to collect and analyze 10 EIA reports and to provide notifications and recom-mendations.

Methods: Ten different types of EIA reports conducted during 2011-2012 were selected. Thenresearchers collected data according to details provided by the reports, follows by analyzing the data.Finally, suggestions and recommendations were provided.

Results:Health in the EIA reports shown in the current situation. Almost of them are numbers of healthfacilities, health personnel, number of in-patient or our patients according to 21 groups of diseasesin that province or district or sub-district, 10 leading cause of deaths. For the assessment of healthimpact – some shown in separated section in the report, methodology they use for assessing healthimpact is mainly Qualitative Health Risk Matrix. It is noticed that occupational health and safety didvery well in the assessment in all ten reports. However, community health impacts are not wellassessed.

Discussions and Conclusions: One area of health that is most developed is in EIA is occupational healthand safety. It means that almost of workers are well protected through policy, measures specific foreach site, while community health need further developed. There are opportunities to expand fromwithin each factory to cover health of the people in communities.

Key words: EIA, health, Thailand

Contact Information: Ms Siriwan ChandanachulakaDirector of Health Impact Assessment Division, Department of Health Ministry of Public Health, NontaburiProvince, 11000, THAILANDPhone +66-2-590-4342 Fax +66-2-590-4356E-mail: [email protected]



Integration of HIA into the EIA report in Vietnam

PHAM Hoai Nam

Department of Appraisal and Environmental Impact Assessment, Ministry of Natural Resources and Environment, Vietnam

EIA in Vietnam

- Tool for environmental planning and management- Impacts identification of project investments- Establishment of appropriate mitigation measures

The natural resources will be efficiently used for the economic development

EIA law and regulations

- Law on Environmental Protection 2005- Decree No. 29/2011/ND-CP of the government on strategic environmental assessment,environmental impact assessment, and environmental protection commitments

- Circular No. 26/2011/TT-BTNMT of Ministry of Natural Resources and Environment (MONRE)on detailed guidelines for some articles of Decree No. 29/2011/ND-CP

Decree No. 29/2011/ND-CP:

- 143 types and sizes of projects required EIA- Industry (industrial parks, power plant, cement factories, sugar mills…), agriculture (irriga-tion…), transportation (airport, expressway, port…), mining, public health (hospital, pharmaceuticalcompanies…), tourism (hotel, resort, golf course…)

Integration of HIA into the EIA report

Law on Prevention and Control of Infectious Diseases 2007:- Investment projects on construction of industrial parks, urban centers, residential areas orinfectious disease examination and treatment establishments can be executed only after theirhealth impact assessment reports have been appraised by competent health agencies

Article 17, Decree No. 29/2011/ND-CP:- Assess and predict project's impacts on natural conditions, natural environment, community andrelated socio-economic factors; community consultation results;

- Propose measures to mitigate negative environmental impacts to the natural conditions, pub-lic health and involved socio-economic factors



EIA report:

- Health issues are only mentioned in general, with the risk of illness, such as: population explo-sion, increases in social vices, traffic accidents, alcohol abuse…

- No report refers a specific action plan to limit and overcome the health risks

Need for integrating HIA into EIA:

- Health risks should be studied more clearly to establish the distinct prevention and mitigationsmeasures

- Decision making should consider in all aspects including economic, engineering, environmen-tal, health and social aspects

- New regulation demands that every investment projects required EIA must be appraised andapproved HIA report

- HIA general guideline must be issued by Ministry of Health and Ministry of Natural Resources andEnvironment

- In EIA report, steps in HIA implementation must be clear and conducted by HA specialists

Contact Information: Hoai Nam PHAM, PhDDepartment of Environmental Impact AssessmentVietnam Environment AdministrationMinistry of Natural Resources and Environment10 Ton That Thuyet (A1802), Cau Giay, Ha Noi, Viet NamMobile: +84 (0) 982 037 555




LocationMapAddress Jinhungro235, Bulgwang-dong, Eunpyeong, Seoul 122-705 KoreaTel (+82-2)380-8000Fax (+82-2)352-9129, 2181

주소 서울시 은평구 진흥로 235

Map

The 4th Asia and Pacific Regional Health Impact Assessment Conferenceand Workshop for Health Impact Assessment in Southeast and East Asian Countries

•Date : October 9-11, 2012•Venue : Korea Institute for Health and Social Affairs, Seoul, Korea•Website : http://hia.kihasa.re.kr/eng


Documents

Conference Program: 4th Asia Pacific Regional Conference on Health Impact Assessment (HIA), Seoul, South Korea, 9-11 October 2012