1. HIA2013, Geneva, 4. October 2013 HIA in developing countries: Untapped potential of health impact assessment Mirko Winkler Ecosystem Health Sciences Unit Health Impact Assessment Group

2. HIA2013: Untapped potential of HIA04.10.2013 2 Potential! Capacities? Achieve universal health coverage Enhance health gains from sustainable development investments and decisions Adopt health indicators to measure progress/ achievements in sustainable development

3. HIA2013: Untapped potential of HIA04.10.2013 Guiding research questions of the paper 1. What is the potential of HIA for linking health to „green economy“ and sustainable development? 2. Where are major gaps in HIA capacities? 3. How can HIA practice be promoted where capacity gaps exist? 3

4. HIA2013: Untapped potential of HIA04.10.2013 The potential of HIA Major drivers of global change Global burden of disease 4 Population growth and urbanisation Demand in natural resources Global climate change

5. HIA2013: Untapped potential of HIA04.10.2013 Major drivers of global change Global distribution of impacts related to major drivers of global change  Ranking as part of the presentation 5 ScoreImpact 1 Lowest 2 Medium 3 High 4 Very high World map by quartiles of Human Development Index (HDI) (2013)

6. HIA2013: Untapped potential of HIA04.10.2013 Major drivers of global change Population growth and urbanisation ScoreTotal 11 33 22 44

7. HIA2013: Untapped potential of HIA04.10.2013 Major drivers of global change Population growth and urbanisation 7 World Urbanization Prospects, the 2011 Revision: Growth rates of urban agglomerations, 1970-2011 ScoreTotal 12 25 46 37

8. HIA2013: Untapped potential of HIA04.10.2013 Major drivers of global change 8 ScoreTotal 13 27 39 411 Demand in natural resources Growing population + urbanization + … + … = Increased demand in natural resources Tropical regions are promising locations for: mineral and energy extraction; production of hydro- and solar-power, as well as biofuel; and food production. Rulli et al., PNAS (2013). Global land and water grabbing. The Economist (2012). Resource nationalism in Africa.

9. HIA2013: Untapped potential of HIA04.10.2013 Major drivers of global change 9 ScoreTotal 14 29 312 415 Global climate change Growing population + urbanization + depletion of natural resources + … + … = Global climate change Global climate change affects the health status of millions of people, particularly those with low adaptive capacity. Patz et al. 2007: Climate Change and Global Health: Cumulative CO2 emissions 1950-2000Distribution of climate-sensitive health effects (malaria, malnutrition, diarrhea, and inland flood-related fatalities)

10. HIA2013: Untapped potential of HIA04.10.2013 Major drivers of global change Global distribution of anticipated health impacts  Rating as part of the presentation 10 Total 4 9 12 15  Major drivers of global change will inordinately affect low- and medium-HDI countries

11. HIA2013: Untapped potential of HIA04.10.2013 Global burden of disease (2010) 11 Blue = Non-communicable diseases Red = Communicable, maternal, neonatal, and nutritional disorders Green = Injuries

12. HIA2013: Untapped potential of HIA04.10.2013 Global burden of disease (2010) 12  The burden of disease in low- and medium-HDI countries poses major qualitative and quantitative challenges

13. HIA2013: Untapped potential of HIA04.10.2013 The potential of HIA  Major drivers of global change will inordinately affect low- and medium-HDI countries  The burden of disease in low- and medium-HDI countries poses major qualitative and quantitative challenges 13  HIA is an ideal tool for raising awareness among decision-makers of the link between health and other factors so that they consider health effects in the planning of policies, programmes and projects Burden of disease in low- and medium-HDI countries Demand in natural resources Population growth and urbanisation Global climate change Adaptation of capacities and services of health systems (e.g. migration) Adaptation of health-related policies and programmes to changing disease epidemiology (e.g. lifestyle changes) Minimize risks of environmental health hazards (e.g. natural disasters)

14. HIA2013: Untapped potential of HIA04.10.2013 Burden of disease in low- and medium-HDI countries Environmental, social, human rights and other impact assessments The potential of HIA 14 Health impact assessment Demand in natural resources Population growth and urbanisation Global climate change

15. HIA2013: Untapped potential of HIA04.10.2013 HIA capacities Current global HIA practice 15 Countries, states and regions that (A) are actively promoting health impact assessment (HIA) through a policy, regulation or other means of endorsement (A) (B) Total 4 9 12 15  Gaps in HIA capacities and policy frameworks are evident and (B) have produced guidelines on HIA (adapted from Hebert et al., 2012)

16. HIA2013: Untapped potential of HIA04.10.2013 Promotion of HIA How can HIA practice be promoted where capacitiy gaps exist? Cornerstones for the promotion and strengthening of HIA practice in developing countries (Caussy, 2003): Existing policy frameworks and procedures Capacity building mechanisms for HIA Institutional infrastructure Intersectoral collaboration 16 In most developing countries, particularly in the African Region, these components are still largely inexistent Increased HIA practice HIA capacity building Interest in HIA approach Demand in HIA approach Awareness of HIA approach HIA community (i.e. practitioners and academics).

17. HIA2013: Untapped potential of HIA04.10.2013 Promotion of HIA 17 Increased HIA practice HIA capacity building Interest in HIA approach Demand in HIA approach Awareness of HIA approach HIA community (i.e. practitioners and academics). Establishment of a regional competence centre in HIA as a priority for the African Region Build awareness of, and interest in, HIA as an approach for health promotion  Demand for HIA at the national and regional levels  Policy frameworks (e.g. requirements for HIA) at national level

18. HIA2013: Untapped potential of HIA04.10.2013 Promotion of HIA 18 Increased HIA practice HIA capacity building Interest in HIA approach Demand in HIA approach Awareness of HIA approach HIA community (i.e. practitioners and academics). Scrutinize and amplify HIA tools and methods so that they are specifically designed for the given context Strengthen the evidence-base for the value and practicability of HIA in low- and medium-HDI countries (e.g. WHO website: 7 out of 61 examples of HIA derive from developing countries) Actively promote partnership with local stakeholders by involving them in the entire HIA process

19. HIA2013: Untapped potential of HIA04.10.2013 The way forward Dissemination WHO’s Western Pacific Regional Office – Thematic working group for HIA PAHO (Jonathan Drewry) Initiative on HIA in the extractive industries/(energy and mining sector?) Initiative around HIA promotion and capacity building in Africa (IAIA14)? Legislation Set of examples deriving from different developing regions (e.g. Mongolia, Thailand, Brazil, Africa?) Capacity building HIA training with a specific focus on developing country settings and challenges (e.g. online course, training modules) Include local human resources in the HIA process! (e.g. Mongolia) 19  Huge joint effort is needed

20. HIA2013: Untapped potential of HIA04.10.2013 Acknowledgments 20 Thank YOU for your attention and interest We thank various colleagues from the WHO Regional Offices and elsewhere for their inputs on national and regional mechanism for the promotion and regulation of HIA