1. From Treatment to Prevention
Health Impact Assessments as a toll for urban management
Dr Carlos Dora
Former Coordinator - Department of Public Health and Environment -
World Health Organization, Geneva
Professor Global Environmental Health Governance – Columbia University, New York
Key messages for mini-campaign

2. What is the health performance of the city you want to build?
How do urban policies and investments:
prevent diseases and premature death among all citizens
enhance child development and enable older people to keep active and functional
creates opportunities for social interaction and quality of life

3. How cities affect your body?
e.g. air pollution, diets and physical activity affects the vascular system causing strokes, heart attacks, lung diseases, dementia
Physiopathology e.g. calcification of artery walls

4. Extensive evidence about health benefits and risks from urban policies
Access to healthy:
housing
transport
green areas
public space
foods
buildings
energy
WatSan
clean air

5. Healthy transport: rapid transit, cycling and walking
Reduce air pollution
Increases physical activity
Reduces traffic injury
Frees urban road/parking for green /public space
Facilitates more equitable access to goods and services
Eases movements of older people, children, disabled, women
Promotes social cohesion in local communities

6. Housing: temperature, ventilation, safety (falls)
« Improved insulation saved months of life per person » (UK Warm Front Programme)
Reduction of respiratory illness by 9% to 20% and increase of individual productivity between 0.48% and 11% with natural ventilation startegies
Photo 1
(graphic, table,
map, etc) zone
« Reduced wheezing, days-off school, doctors' visits were reported by occupants of insulated homes «  (NZ Insulation study)
You can say that a 19th century public health worker in New York/San Francisco Tenements would know that:
Better insulation protects from health impacts of: storms, mould, heat & cold;
Good ventilation protects from TB
Screens protect from mosquito-borne diseases
I would put this in the positive… and emphasize equity benefits.

7. Access to healthy foods
Less sugar
Less fat,
More vegetables, fruits and nuts,
Less:
Obesity,
Cardio-vascular d. Cancer

8. Access to public and green spaces
Encourage physical activity
Shady areas can reduce the "heat-island" effect in urban area
Green spaces have important psychosocial benefits
Trees and vegetation absorb some air pollution
Can separate people from pollution sources (highways)

9. Solutions: Support Policies with Health benefits,
Health impacts:
Falls
Dementia,
Heart disease
Stroke
Respiratory
cancer
Injuries,
Air pollution, noise
Physical activity, diet
Functional capacity
Mental health
Social interaction

10. HIA procedure Screening Scoping Appraisal Reporting Monitoring
Quickly establishes "health relevance" of the policy or project. Is HIA required?
Identifies key health issues & public concerns, establishes ToR, sets boundaries.
Rapid or in-depth assessment of health impacts using available evidence – who will be affected, baseline, prediction, significance, mitigation.
Conclusions and recommendations to remove/mitigate negative impacts on health or to enhance positive.
Action, where appropriate, to monitor actual impacts on health to enhance existing evidence base.
Policy, programme , or project development phase for prospective assessments.
Policy or project implementation phase
HIA can be carried out as an independent or parallel assessment or it can be integrated as part of another assessment, for example:
Strategic Environmental Assessment (SEA)‏
Environmental Impact Assessment (EIA)‏
Environment and social impact assessment (ESIA)‏
Sustainability assessment
Integrated impact assessment
Social impact assessment
Poverty impact assessment
and many others….
Take away:
graphic depicting how HIA can fit into the project cycle as part of existing environment and social impact assessment requirements.

11. How is health influenced by transport?
(Watkiss et al, 2003)

12. Urban Health Initiative Catalyzing Change

13. Levels of urban transformation
Urban leaders act - changes in policies, air quality, climate & health indicators are tracked
Communications intensify demands for change
Alternative scenarios tested – vision for healthy urban future articulated
Tools for assessing health and economic benefits
Health policymakers build competencies
Current policies and stakeholders assessed and mapped

14. Current urban policies and stakeholders assessed and mapped
Current policies with major impacts on health are mapped along with key stakeholders in urban health and urban development sectors and civil society

15. Health professionals build competencies
Health policymakers build competencies in assessing health and economic impact of policies and in advising other sectors on urban environmental health risks.
Health care workers equipped to advise patients on protective measures

16. Tools for assessing health and economic benefits
Tools for assessing health and economic arguments such as WHO’s AirQ+, HEAT and One Health adapted and used locally.
Tools for front line health care workers to advise patients & communities
HIA
AirQ+
HEAT
Health economic assessment for walking/cycling

17. Alternative scenarios assessed and tested
Alternative scenarios based on policy options tested or considered locally to estimate potential health and economic impacts

18. Transport scenarios for Sao Paulo, Brazil:
Changes in DALYs for each scenario attributable to changes from air quality, physical activity and road injuries
Sá et al. 2017

19. Communications intensify demands for change
Urban leaders and champions engaged to communicate costs of inaction, including thorough global BreatheLife Campaign, intensifying demand for action.
Health care workers advise patients & communities about prevention

20. Urban leaders act - changes in air quality, climate & health indicators monitored and tracked
Health and economic arguments provide urban leaders with incentive to act; changes in air pollution and related policies monitored and tracked, using WHO Global Urban Ambient Air Pollution Database
Designed by Inis Communication • Illustration elements from

21. Visualize a healthier future Track progress in the trajectory
And many of the cities that are succeeding are doing so not with mass incarceration but by studying violence with public health surveillance, and by working to reduce vulnerability
Visualize a healthier future
Track progress in the trajectory