Health impact assessment : environmental management vs healthy public policy perspective - exploring the nexus between the two

This paper will explore the links between the traditional role of HIA in an environmental management context and the new and emerging trend internationally to subject government policy to prospective HIA.  The goal of this new iteration of HIA is to develop healthy public policy across all sectors of government creating a more inclusive and evidence-based approach to public policy formation.  The risk-based, health protection approach is more widely understood, as it draws on existing health protection experience and is allied with risk assessment theory.  The new model is based on the health promotion perspective, and emphasizes social determinants of public health.  This latter approach draws on the foundations of the former.  It is vital that the links between the two are therefore considered especially from the perspective of transfer of knowledge between the two.  The paper will explore the similarities, the differences, the tensions and the lessons that can be learned.  It will report on the progress of a national study being conducted by Mary Mahoney and Gillian Durham that is looking at what is happening (or has happened) in other countires including Canada, New Zealand, Sweden, Netherlands, Germany and the United Kingdom

Sustainability and health : supporting global ecological integrity in public health

Radical changes in the biosphere and human interaction with the environment are increasingly impacting on the health of populations across the world. Diseases are crossing the species barrier, and spreading rapidly through globalized transport systems. From new patterns of cancer to the threat of global pandemics, it is imperative that public health practitioners acknowledge the interdependence between the sustainability of the environment and the sustainability of the human species.* Why are issues of global and local sustainability of increasing importance to the public's health?* Why do issues of sustainability require new practices within the professions of public health?* How can future and current public health practitioners develop those new practices?Drawing on scientific evidence of global and local environmental changes, Sustainability and Health offers a thorough background and practical solutions to the overlapping issues in environment and health. It examines potential and existing responses to global and local environment and health issues, involving individuals, community, industry and government. The authors introduce a range of emerging conceptual frameworks and theoretical perspectives, link IT and epidemiology and explain how scoping can link program design, delivery, data collection and evaluation in projects from their very beginning. Public health practitioners need to be able to manage health issues that cut across environmental, economic and social systems and to develop the capacity for leadership in facilitating change. Incorporating learning activities, readings, international case studies and an open learning approach, this is a valuable resource for students of public and environmental health, as well as medical, environmental and health science professionals.

Using environmental interventions to create sustainable solutions to problems to health and wellbeing

Recent research by Deakin University, in collaboration with Parks Victoria and its Strategic Partners, indicates that contact with nature may promote human health and wellbeing. International research indicates that simply viewing a natural scene or watching wildlife reduces stress and tension, improves concentration, remedies mental fatigue, boosts immunity, and enhances psychological health. This is aside from any physical health benefits flowing from reduced stress, increased exercise and improved air quality when contact with nature involves activities in natural environments. The literature suggests that interacting with nature through gardening or having a companion animal is also beneficial for health, and where these activities involve contact with other humans, might extend benefits beyond the individual to the community, through enhanced social capital. This paper sets out the potential scope of work flowing from the initial research, in terms of target groups, research foci, intervention strategies, and likely benefits, and reports on progress in establishing a program of Australian,based empirical research. It proposes the establishment of alliances between researchers and practitioners in a range of disciplines (including environmental health) to ensure that the links between contact with nature and human health and wellbeing are explored and expressed in ways that are both beneficial and sustainable.

Domestic drinking water in rural areas : are water tanks on farms a health hazard?

The aim of the research was to gain a better understanding of the relationship between drinking water quality, householders' knowledge and maintenance practices of private water supplies and drinking water-related public health risk on farms. Samples of drinking water were taken from 100 farming households. The Colilert-18 method was used for the detection of total coliforms and Escherichia coli (E. coli) as indicators of water quality. Each household completed a questionnaire about their knowledge and practices relating to a safe water supply. Coliforms were present in 52 water samples and E. coli was present in 38. Seven households reported minor illnesses in the previous three months and two households reported gastroenteritis. Some tank maintenance occurred in 86 households, but tank maintenance activities varied considerably. Four of the households had published guidelines on water quality. None of the participating households had their drinking water tested regularly. There was no obvious relationship between drinking water quality, householder knowledge, maintenance practices and drinking water-related health risk on farms.

Health systems change in 2010

Whilst health science, epidemiology and public health developments have forged enormous progress in understanding, prevention and cure in the health care area we still appear to lack the motivation to tackle the fundamental antecedents of many of our emerging population-based community health problems; the prevention of chronic illness being a prime example.

In spite of much progress in the area of health science, the social, economic and evolutionary forces that cast our physical being in the world still remain poorly understood or accepted in the health care arena. However, if our health care systems are to be manageable and sustainable in the future, these wider antecedents of our health status and wellbeing must be factored more fundamentally in to our management models with more effort being put into preventing lifestyle related chronic illnesses than is currently the case.

As in the past where public health infrastructure innovations such as running water and efficient waste disposal systems served to add greatly to the wellbeing of individuals and communities, we now need to make similar efforts to control preventable illnesses such as metabolic syndrome, type 2 diabetes and lifestyle related cardio-vascular disease at their source rather than waiting until the manifestation of these conditions require major medical and chemical intervention and management before we act. Our young people are at risk of early onset chronic conditions as a result of their emerging sedentary lifestyles, un-healthy dietary habits and health related behaviours, yet we continue to concentrate our health management effort on managing those with existing chronic conditions while leaving younger generations with lifestyle practices and behaviours that pre-dispose individuals to developing chronic illness earlier and earlier in their lives.

It is time we took notice of these emerging trends and began expending more effort to prevent what are essentially lifestyle related illnesses that can be eliminated before they become endemic. By concentrating more upon the social and environmental factors affecting our illness profiles as well as upon dealing more effectively with those who are already suffering from chronic illness we will reduce the need for major end-stage interventions and alleviate the impact and cost of early onset chronic disease. To achieve this new population health vision in Australia at least, we will not only need to utilize the new government funding structures more effectively; those structures that support coordination and more effective management of care, but also take a much broader, environmental and social view of cause and effect in relation to the health of populations.

Ecosystems and human well-being : health synthesis

This report synthesizes the findings from the Millennium Ecosystem Assessment's (MA) global and sub-global assessments of how ecosystem changes do, or could, affect human health and well-being. Main topics covered are: Food, fresh water, timber, fibre, and fuel, nutrient and waste management, pollution, processing and detoxification, cultural, spiritual and recreational services, climate regulation, and extreme weather events.

Aquaculture effluent : impacts and remedies for protecting the environment and human health

Knowledge in the field of environmental health is growing rapidly. Within the context of external factors that define its boundaries, environmental health has evolved over time into a complex, multidisciplinary and ill-defined field with uncertain solutions. Many of the key determinants and solutions to environmental health lie outside the direct realm of health and are strongly dependent on environmental changes, water and sanitation, industrial development, education, employment, trade, tourism, agriculture, urbanization, energy, housing and national security. Environmental risks, vulnerability and variability manifest themselves in different ways and at different time scales. While there are shared global and transnational problems, each community, country or region faces its own unique environmental health problems, the solution of which depends on circumstances surrounding the resources, customs, institutions, values and environmental vulnerability. This work will contain critical reviews and assessments of environmental health practices and research that have worked in places and thus can guide programs and economic development in other countries or regions.

Managing the risks from new and emerging infectious disease: the 'one health' paradigm

The global risk from new and emerging infectious diseases continues to grow with recognition that, for the most part, the pathogens involved emerge from animals to infect humans. Recognizing the complexity of these interactions and the need for a strong interdisciplinary approach to effectively manage these risks, new partnerships are being forged under the general umbrella of 'one health'. Involving human health, animal health, and environmental health exponents, solutions are sought for how to prevent as well as respond to the threats. But is this approach working? Whilst a number of key meetings continue to be held under the One Health umbrella, are we really seeing measureable progress in risk prevention and mitigation? Focusing research on the drivers for emergence, on modeling the risks, on improved diagnostics, and on targeted vaccines could considerably enhance our ability to prevent and respond. Ensuring the uptake and applications of new diagnostics and vaccines will be the key to prevention and response, but achieving this will require policies that drive further the One Health collaborations. Such policies should ensure that scant available resources are targeted toward the identified outcomes through research delivery and uptake, and that we genuinely work as "one world" in tackling the very real risks we face

A participatory workplace health and safety training program for ethylene oxide

The Occupational Safety and Health Administration (OSHA) has regulated ethylene oxide (EtO) on the basis of its acute toxicity and its potential carcinogenic and reproductive effects since 1971. OSHA's 1984 EtO standard and its 1988 revisions focused new attention on health and safety training and other preventive measures. An EtO health and safety training program for hospital sterilization workers was developed by the staff of an independent occupational and environmental health clinic. Participatory and empowerment training methods were central to the approach. Also included were hands-on, demonstration, interactive presentation, and other methods. An EtO Health and Safety Training Manual was developed based on the training experiences. This paper presents the challenges, benefits, and limitations of incorporating participatory and empowerment approaches in the design, implementation, and evaluation of EtO health and safety training.

Rural health systems change

Much effort has been expended in recent years attempting to reform the Australian health system in order to deliver more efficient and effective systems of care for an ageing and increasingly chronically ill population. Rural health care systems in particular have been a focus of reform programs, and new initiatives such as University Departments of Rural Health, Regional Health Service structures and Commonwealth primary care initiatives have been designed to improve service provision and health status for rural people. However, with these attempts to reform the way rural communities understand and manage their health care, surprisingly little has changed in the day-to-day business of health care in rural and regional areas. Paradoxically, while rural communities have moved to embrace new farming technologies and environmental perspectives along with modern land management practices, revegetation and sustainable production systems, the same enthusiasm for change does not appear to have been kindled in relation to health system reforms. Rural communities, in terms of health care, are still using the equivalent of outmoded farming practices and other environmentally and economically unsustainable approaches to managing their affairs. Why might this be and what can be done to improve the current state of health reform in our rural and regional areas? The paper explores systems change in relation to health reform in rural communities and highlights several strategies for bringing about a functional synthesis of research and health service practice to create a more effective health care system in rural South Australia.

Sustainable population health : a pressing priority for community wellbeing

Recent developments in primary health care, preventive care, early intervention programs, population health constructs and coordinated care trials in Australia have explored the idea of changing our emphasis in health care from responsive acute care to more integrated, whole population community wellbeing management. This idea accepts that much illness and even trauma experienced by individuals in our communities can be prevented, mitigated or managed in a more constructive and positive manner than has previously been the case. Much disabling illness need not occur at all and can be avoided through better community based management models, education programs, and lifestyle changes that contribute to more healthy communities. As in the wider business world, we are becoming more cognisant of the fact that prevention is not only an appealing idea in terms of health outcomes and quality of life, but that it is good for business also. It can moderate demand for costly health care, assist consumers to understand how to live healthier and fulfilling lives and overall help to sustain a much more dynamic community. This article, based on work in a rural health service in South Australia, points to some elements of sustainable primary care that appear to have potential to take us where we need to go. It asks whether we have the capacity and the will to make the necessary investment in sustainability to ensure our future or whether we are to remain bound in a reactionary model of health care rather than considering the impact of wider social and physical environments as part of the overall community health equation.

Perceived neighborhood environmental attributes sssociated with walking and cycling for transport among adult residents of 17 cities in 12 countries: the IPEN study

INTRODUCTION: Prevalence of walking and cycling for transport is low and varies greatly across countries. Few studies have examined neighborhood perceptions related to walking and cycling for transport in different countries. Therefore, it is challenging to prioritize appropriate built-environment interventions. OBJECTIVES: The aim of this study was to examine the strength and shape of the relationship between adults' neighborhood perceptions and walking and cycling for transport across diverse environments. METHODS: As part of the International Physical activity and Environment Network (IPEN) adult project, self-reported data were taken from 13,745 adults (18-65 years) living in physically and socially diverse neighborhoods in 17 cities across 12 countries. Neighborhood perceptions were measured using the Neighborhood Environment Walkability Scale, and walking and cycling for transport were measured using the International Physical Activity Questionnaire-Long Form. Generalized additive mixed models were used to model walking or cycling for transport during the last seven days with neighborhood perceptions. Interactions by city were explored. RESULTS: Walking-for-transport outcomes were significantly associated with perceived residential density, land use mix-access, street connectivity, aesthetics, and safety. Any cycling for transport was significantly related to perceived land use mix-access, street connectivity, infrastructure, aesthetics, safety, and perceived distance to destinations. Between-city differences existed for some attributes in relation to walking or cycling for transport. CONCLUSIONS: Many perceived environmental attributes supported both cycling and walking; however, highly walkable environments may not support cycling for transport. People appear to walk for transport despite safety concerns. These findings can guide the implementation of global health strategies.

Unhealthy landscapes: policy recommendations on land use change and infectious disease emergence

Anthropogenic land use changes drive a range of infectious disease outbreaks and emergence events and modify the transmission of endemic infections. These drivers include agricultural encroachment, deforestation, road construction, dam building, irrigation, wetland modification, mining, the concentration or expansion of urban environments, coastal zone degradation, and other activities. These changes in turn cause a cascade of factors that exacerbate infectious disease emergence, such as forest fragmentation, disease introduction, pollution, poverty, and human migration. The Working Group on Land Use Change and Disease Emergence grew out of a special colloquium that convened international experts in infectious diseases, ecology, and environmental health to assess the current state of knowledge and to develop recommendations for addressing these environmental health challenges. The group established a systems model approach and priority lists of infectious diseases affected by ecologic degradation. Policy-relevant levels of the model include specific health risk factors, landscape or habitat change, and institutional (economic and behavioral) levels. The group recommended creating Centers of Excellence in Ecology and Health Research and Training, based at regional universities and/or research institutes with close links to the surrounding communities. The centers' objectives would be 3-fold: a) to provide information to local communities about the links between environmental change and public health ; b) to facilitate fully interdisciplinary research from a variety of natural, social, and health sciences and train professionals who can conduct interdisciplinary research ; and c) to engage in science-based communication and assessment for policy making toward sustainable health and ecosystems.