1. Prediction and evidence Session 5 Health in SEA

2. SEA Directive requirements “The likely significant effects on the environment including on issues such as biodiversity, population, human health, fauna, soil water air, climatic factors, material assets, cultural heritage including architectural and archaeological heritage landscape and the interrelationship between the above factors. Note f Fig 1 Practical Guidance on SEA Directive ODPM

3. SEA Directive (2) Assessment of effects should include “secondary, cumulative, synergistic, short, medium and long-term permanent and temporary, positive and negative effects”. Article 5(1) “Characteristics of the effects and of the area likely to be affected, having regard, in particular, to …. the risks to human health or the environment (e.g. due to accidents)”. Annex II 2

4. Aim of impact assessment is to predict (forecast) the health consequences if different options are chosen.

5. CFC and Skin Cancer Excess cases in USA on 3 different scenarios Baseline 2000 cases per million per year Slaper H et al (1996) Nature 384, 256-258.

6. Prediction techniques Figure 18 Practical Guide to SEA Directive ODPM 2005 Expert judgement – Formal dose response analysis – Expert opinion Public participation Modelling Scenario analysis GIS Quality of life capital Network analysis Multi criteria analysis Ecological footprints Compatibility assessment

7. Reasons for Participation in HIA Because it is a good thing? Source of evidence Transparency - right to know “Little democracy” Conflict management Social learning

8. Participation & prediction Hopes and fears Perceptions Different logic pathways Community responses Stories Meanings

9. Consultation bodies England Specified by regulation Natural England English Heritage Environment Agency Different bodies in devolved administrations

10. Consultation and SEA Consultation is a very weak form of participation Consultation must involve consultation bodies (CB) – useful to involve others Must consult with CB for scoping stage Must consult CB and public on draft plan and environmental report Make full use of existing consultation processes

11. Discussion What is evidence for SEA

12. USNRC Risk Assessment Model Hazard Identification Risk Management Risk evaluation Regulatory options Evaluate Consequences Risk Characterisation Dose Response Assessment Exposure Assessment

13. Dose response curves

14. % Change in risk of death on days with raised PM 10 concentrations (Compared to risk on days below 15 ug/m 3 ) PM 10 (ug/m 3 ) Schwartz J. Occup & Environmental Medicine 2004; 61, 956-961

15. Producing dose response curves Natural experiment Occupational exposures Cross sectional observations Time series But are associations causal? And are they reversible? Confounding Generalisability

16. Social networks and mortality (Almeda county study) Social Network Index Source Berkman 1987 Rev Epid et Sante Publ 35, 46-53

17. The limits of science If residents are concerned about a possible health hazard And you demonstrate with sound science that it does not pose any risk to health It remains a problem because residents think it is a problem i.e. So long as someone thinks it is a health problem it is a health problem

18. Some Determinants Employment Income Education Housing Built environment Amenity Education Crime (Fear of) Discrimination Social Cohesion Family structure Civic pride

19. Causal Paths Inter- vention New road New policy etc, etc Intermediate factor Air pollution Income Employment Housing etc, etc. Health Impact Mortality Hospital admissions etc, etc Nearly all health effects are indirect

20. Causal Pathways for Transport Policy Outcomes Traffic Volume & Speed Exposure Concentrations in air Emission of pollutants Global warming  Physical Activity  Social Use of Outdoor Space Health Mental & Physical Internal Dose Dose Journeys not made Injuries Noise Stress Community Severance  Access Perceived danger of cycling & walking

21. Los Angeles Living Wage Ordinance Causal Paths After Cole et al JECH 2005: 59, 645-650 Living wage ordinance min $7.25/hr+ Health insurance Health Insurance Social Support Stress Health behaviours Children’s education Childcare Housing Health care Increased income Mental health Outcomes Physical health Outcomes Policy Health Outcome Intermediate Impact Proximal Impact

22. INTERVENTIONHEALTH OUTCOME  excise duty  early intervention  school alcohol education  adult alcohol education  drink driving controls  licensed outlets Restrict advertising  tax take  treatment Policing of bars etc Enforce safer drinking venues  OVERALL CONSUMPTION ↓ alc social interaction ↓ alc income ↓ alc. employment  money for health & welfare  smuggling  HEAVY/BINGE DRINKING  alc RTA  heart disease etc  breast cancer  ill health  well being  ill health  well being  alc violence  alc antisocial behaviour  alc family problems  law abiding  alc related disease Causal pathways in alcohol policy

23. Not everything that can be counted counts, and not everything that counts can be counted. Attributed to Albert Einstein (1879 - 1955)

24. Which pathways? Easy Air pollution Water pollution Noise Traffic injuries Difficult Employment Income Community severance Crime Amenity Community cohesion