Consideration on the health risk reduction related to attainment of the new particulate matter standards in Poland:a top-down policy risk assessment

Policies can influence health of a population in various ways. Numerous epidemiological studies supported by toxicological investigations demonstrate a positive association between ambient concentrations of airborne particulate matter and increased adverse cardio-respiratory events, including morbidity and mortality. The aim of this paper was to present the concept of the top-down health policy risk assessment approach model developed to estimate the expected health risk reduction associated with policy aiming at attaining the new particulate matter ≤ 10 μm in diameter (PM10) standards in Poland. The top-down approach guides the analysis of causal chains from the policy to health outcomes. In this case study we tried to estimate the predicted health effects of the policy change over the past 20 years. Since Polish annual standard for PM10 changed from 50 μg/m3 in 1990 to 40 μg/m3 in 2010, we calculated the relative risk associated with decreasing PM10 in diameter to 10 μg/m3 in the annual level of PM10 for 6 adverse health effects. The relative risk slightly decreased for almost all adverse health effects, which means that the relative decrease in the incidence of health effects from the baseline incidence should range from about 0.5–0.6% for heart disease admissions to > 1% for respiratory admissions. The obtained results indicate that implementation of the new ambient air standards could influence improvement of the health status of Polish population. A top-down policy health risk assessment model can be one of the main tools in this process, providing harmonized guidance how to seek evidence-based information, which could serve policy-makers

Public Health Challenges and Priorities for Kazakhstan

The Republic of Kazakhstan is one of the largest and fastest growing post-Soviet economies in Central Asia. Despite recent improvements in health care in response to Kazakhstan 2030 and other state-mandated policy reforms, Kazakhstan still lags behind other members of the Commonwealth of Independent States of the European Region on key indicators of health and economic development. Although cardiovascular diseases are the leading cause of mortality among adults, HIV/AIDS, tuberculosis, and blood-borne infectious diseases are of increasing public health concern. Recent data suggest that while Kazakhstan has improved on some measures of population health status, many environmental and public health challenges remain. These include the need to improve public health infrastructure, address the social determinants of health, and implement better health impact assessments to inform health policies and public health practice. In addition, more than three decades after the Declaration of Alma-Ata, which was adopted at the International Conference on Primary Health Care convened in Kazakhstan in 1978, facilitating population-wide lifestyle and behavioral change to reduce risk factors for chronic and communicable diseases, as well as injuries, remains a high priority for emerging health care reforms and the new public health. This paper reviews the current public health challenges in Kazakhstan and describes five priorities for building public health capacity that are now being developed and undertaken at the Kazakhstan School of Public Health to strengthen population health in the country and the Central Asian Region

Analysis of Health in Environmental Assessments:A Literature Review and Survey with a Focus on Denmark

In the European Union, the Environmental Impact Assessment (EIA) Directive (2014/52/EU) and Strategic Environmental Assessment (SEA) Directive (2011/92/EU) emphasise the assessment of population and human health. The directives require health to be considered within Environmental Impact Assessment (EIA) and Strategic Environmental Assessment (SEA). To date, health is mainly considered in connection with negative environmental factors and in terms of risk assessments. The integration of health in EIA as well as SEA has not been investigated in a Danish context, and this study aims to address the missing knowledge. There is a need for a more comprehensive health assessment within EIA and SEA to comply with the EIA and SEA directives. An integration of health into EIA and SEA will ensure a sound examination of health determinants which can improve decision making and thus comprehensively promote and protect health. To establish the status of the inclusion of the assessment of impacts on health into EIA and SEA, a literature review was performed. In addition, a survey addressed to researchers and practitioners was conducted and analysed through a comparative analysis. The survey examined the needs of practitioners and researchers, focusing on the Danish context, regarding the inclusion of health into EIA and SEA. Enhanced intersectoral cooperation of the health and environmental sectors, more specific guidance documents, and underlying this, stronger political support, were identified among needs for more comprehensive health assessments

Obstacles and Opportunities for Diffusion of Integrated Pest Management Strategies Reported by Bolivian Small-Scale Farmers and Agronomists

Integrated pest management (IPM) with an increased used of ecological farming methods and less and safer use of pesticides offers solutions to reduce risks of developing pest resistance, human poisoning, and environmental pollution. Despite being promoted by Food and Agriculture Organization and others, it has not spread readily in low-income countries. This article presents the opinions of Bolivian farmers and agronomists on perceived obstacles and opportunities for a diffusion of IPM. Focus group discussions revealed an increased workload without certainty of higher yields or better prices for products grown with IPM compared with traditional agriculture being hindrances for a spread of IPM. Moreover, IPM requires some new practices not that easy to learn by farmers. In favor of IPM was an increasing awareness of the importance of a healthy and sustainable food production, easiness to try out without expensive investments needed, and a higher quality of the products. A healthy and sustainable agricultural production should be promoted by support to farmers through IPM training, a certification, and better prices. Finding allies to such a promotion is not easy, though, according to both farmers and agronomists

Obstacles and Opportunities for Diffusion of Integrated Pest Management Strategies Reported by Bolivian Small-Scale Farmers and Agronomists

Integrated pest management (IPM) with an increased used of ecological farming methods and less and safer use of pesticides offers solutions to reduce risks of developing pest resistance, human poisoning, and environmental pollution. Despite being promoted by Food and Agriculture Organization and others, it has not spread readily in low-income countries. This article presents the opinions of Bolivian farmers and agronomists on perceived obstacles and opportunities for a diffusion of IPM. Focus group discussions revealed an increased workload without certainty of higher yields or better prices for products grown with IPM compared with traditional agriculture being hindrances for a spread of IPM. Moreover, IPM requires some new practices not that easy to learn by farmers. In favor of IPM was an increasing awareness of the importance of a healthy and sustainable food production, easiness to try out without expensive investments needed, and a higher quality of the products. A healthy and sustainable agricultural production should be promoted by support to farmers through IPM training, a certification, and better prices. Finding allies to such a promotion is not easy, though, according to both farmers and agronomists

Environmental Impact Assessment, Human Health and the Sustainable Development Goals

Objectives: Developmental processes influence the determinants of health and, consequently, human health. Yet, assessing human health impacts in impact assessment, with exception of health impact assessment, is still rather vague. Inclusion of Sustainable Development Goal indicators in environmental impact assessment (EIA) is an opportunity to enhance addressing human health in EIA practices. Methods: We reviewed a list of health-related targets and indicators for SDGs as defined by the Institute of Health Metrics and Evaluation (IHME) in Seattle, WA, United States with the aim of identifying those to be suggested as outcome indicators within EIA. Results: Among 42 health-related indicators, we identified 17 indicators which could be relevant for impact assessment procedures and categorized them into three groups: 1) direct health indicators (e.g., under five mortality). 2) complex indicators (e.g., cancer). 3) environmental determinant indicators (e.g., mean PM(2.5)). Conclusion: All 17 indicators can be employed to improve quantification assessing human health impacts and bring SDGs into EIA processes. Though our assessment has been conducted for Denmark and the set of suggested indicators could be different for contexts in other countries, the process of their identification can be generalized

Unemployment and Causes of Hospital Admission Considering Different Analytical Approaches

The association between unemployment and hospital admission is known, but the causal relationship is still under discussion. The aim of the present analysis is to compare results of a cross-sectional and a cohort approach considering overall hospital admission and hospital admission due to cancer and circulatory disease. Register-based data were analysed for the period of 2006–2009. In the cross-sectional analysis, a multiple logistic regression model was conducted based on the year 2006, and cohort information from the same year onward up to 2009 was available for a Cox regression model. Social welfare compensated unemployment and both types of disease-specific hospital admission were associated to be statistically significant in the cross-sectional analysis. With regard to circulatory disease, the cohort approach suggests that social welfare compensated unemployment might lead to hospital admission due to the disease. Given the significant results in the cross-sectional analysis for hospital admission due to cancer, the unfound cohort effect might indicate a reverse causation suggesting that the disease caused joblessness, and finally social welfare compensated unemployment and not vice versa. Comparing different study designs allows for a better causal interpretation, which should be recommended in future quantitative social welfare analysis

Assessment of health risks of policies

The assessment of health risks of policies is an inevitable, although challenging prerequisite for the inclusion of health considerations in political decision making. The aim of our project was to develop a so far missing methodological guide for the assessment of the complex impact structure of policies. The guide was developed in a consensual way based on experiences gathered during the assessment of specific national policies selected by the partners of an EU project. Methodological considerations were discussed and summarized in workshops and pilot tested on the EU Health Strategy for finalization. The combined tool, which includes a textual guidance and a checklist, follows the top-down approach, that is, it guides the analysis of causal chains from the policy through related health determinants and risk factors to health outcomes. The tool discusses the most important practical issues of assessment by impact level. It emphasises the transparent identification and prioritisation of factors, the consideration of the feasibility of exposure and outcome assessmentwith special focus on quantification. The developed guide provides useful methodological instructions for the comprehensive assessment of health risks of policies that can be effectively used in the health impact assessment of policy proposals.