The role of health impact assessment in Phase V of the Healthy Cities European Network

Health impact assessment (HIA) is a prospective decision-making aid tool that aims to improve the quality of policies, programmes or projects through recommendations that promote health. It identifies how and through which pathways a decision can impact a wide range of health determinants and seeks to define the distribution of effects within populations, thereby raising the issue of equity. HIA was introduced to the WHO European Healthy Cities Network as one of its four core themes during the Phase IV (2004-08). Here we present an evaluation of the use of HIA during Phase V (2009-13), where HIA was linked with the overarching theme of health and health equity in all local policies and a requirement regarding capacity building. The evaluation was based on 10 case studies contributed by 9 Healthy Cities in five countries (France, Hungary, Italy, Spain and the UK). A Realist Evaluation framework was used to collect and aggregate data obtained through three methods: an HIA factors analysis, a case-study template analysis using Nvivo software and a detailed questionnaire. The main conclusion is that HIA significantly helps promote Health in All Policies (HiAP) and sustainability in Healthy Cities. It is recommended that all Healthy City candidates to Phase VI (2014-18) of the WHO Healthy Cities European Network effectively adopt HIA and HiA

Patient perceptions and expectations regarding imaging for metastatic disease in early stage breast cancer

Abstract Purpose The probability of detecting radiologically evident metastatic disease in asymptomatic women with newly diagnosed operable breast cancer is low. Despite the recommendations of most practice guidelines imaging is still frequently performed. Relatively little is known about what patients believe is important when it comes to radiologic staging. Methods Patients with early stage breast cancer who had completed their definitive breast surgery were surveyed about their personal experiences, perceptions, and expectations on the issue of perioperative imaging for distant metastatic disease. Results Over a 3 month period, 245 women with primary operable breast cancer completed the questionnaire (87.0% response rate) and 80.8% indicated having had at least one imaging test for distant metastatic disease. These were either of the thorax (72.2%), abdomen (55.9%) or skeleton (65.3%) with a total of 701 imaging tests (average of 3.5 tests per patient imaged) performed. Overall, 57.1% indicated that they would want imaging done if the chance of detecting metastases was ≤10%. Although 80.0% of patients indicated that, “doing whatever their doctor recommended” was important to them, 70.4% also noted that they would be uncomfortable if their physician did not order imaging, even if this was in keeping with practice guidelines. Conclusions Most patients with early stage breast cancer recall having imaging tests for distant metastases. Given the choice, most would prefer having imaging performed, even if this is not in line with current guidelines. If patient expectations are, in part, driving excessive imaging, new strategies addressing this are required

Positive association of walking with the use of public transport in Switzerland

Promoting physical activity and active transport strategies are among the “best buys” for tackling the risk factors of noncommunicable diseases (WHO Global status report on noncommunicable diseases, 2010). Operationalising such insights requires policies favourable to health in the transport sector. In Switzerland and many other countries, the transport sector has its own agenda which includes increasing walking, cycling and public transport patronage, and reducing car use – or at least limiting it to areas or purposes not easily covered by other transport modes. It is clear to most transport sector professionals that reducing car use and favouring other modes not only alleviates traffic congestion, but also contributes to reducing noise, air pollution, energy consumption and greenhouse gas emission. However, many transport strategies have trouble integrating health into their argumentation plans. Air pollution is sometimes mentioned, however improvements in motor and fuel quality standards have weakened this argument. What remains under-explored is the potential of a reduction in car use and/or an increase in public transport use to increase daily walking. Given the current global epidemic of sedentariness, overweight and obesity, this deserves to be explored further. We used the Swiss transport micro-survey (MTMT2010) – a complex database where 62’868 people describe their transport behaviour on randomly selected reference days – to investigate associations between walking and the use of other transport modes. Linear regression was carried out using kilometres walked as the dependent variable. We found walking to be positively associated with public transport use and negatively associated with the use of a private motorised vehicle. The proportion of variance in walking distances explained is around 3% (p<0.001). Interestingly, the use of public transport has a stronger (positive) effect on walking distance that the (negative) effect of car or motorbike use. These results supply evidence that policies aiming to transfer mobility from cars towards public transport are likely to bring about increases in walking and therefore public health gains. These results may also be used as inputs for further research, including Health Impact Assessments which may be carried out on future transportation policies

Health Priorities in French-Speaking Swiss Cantons

In Switzerland, the federal authorities, the cantons, and the communes share the responsibility of healthcare, disease prevention and health promotion policies. Yet, the cantons are in most health matters independent in their decisions, thus defining as a matter of fact their own health priorities. We examined and analysed the content of the disease prevention and health promotion plans elaborated during the last decade in six French-speaking cantons with different political contexts and resources, but quite similar population health data, in order to identify the set health priorities. The plans appear significantly inhomogeneous in their structure, scope and priorities. Most of the formal documents are short, in the 16 to 40 pages range. Core values such as equity, solidarity and sustainability are explicitly put forward in 2/6 cantonal plans. Priority health issues shared by all 6 cantons are “physical activity/ sedentariness” and “nutrition/food.” Mental health is explicitly mentioned in 5 cantonal plans, whereas tobacco and alcohol consumptions are mentioned 4 times. Less attention has been given to topics that appear as major public health challenges at present and in the future in Switzerland, eg, ageing of the population, rise of social inequalities, increase of vulnerable populations. Little attention has also been paid to issues like domestic violence or healthy work environments. Despite some heterogeneity, there is a common base that should make inter-cantonal collaborations possible and coordination with national strategies easily feasibl

Why is promoting daily walking not a priority in European cities? A review and research agenda

Promoting daily walking is one of the most efficient means of improving urban health, but is rarely recognised as a priority at city level. This contribution investigates the hypothesis that evidence about the importance of walking is having a limited effect on urban policy in Europe, because walking is not defined as a priority in key documents used by policy makers in cities. Detailed secondary analysis was carried out on documents used for the evaluation of Phase V of the WHO Healthy Cities European Network (159 case studies, 71 city responses to a general questionnaire), and on relevant UN/WHO publications and published articles. Cities or case studies involving walking were selected for a second round of investigation. Alignment between walking policies and Healthy Cities core activity areas was evaluated by the authors independently, then validated in an open discussion. Two Phase V core themes related to walking were identified: healthy living, and healthy urban environment and design. Within the latter, "healthy urban design" was identified among 8 "important issues". It is defined as "creating socially supportive environments and an environment that encourages walking and cycling". In their responses to the questionnaire, 16 cities mentioned walking but only 2 of the case studies addressed daily urban walking. Furthermore, none of the UN Sustainable Development Goals (SDGs) mentioned walking explicitly. Daily urban walking plays a minor role among WHO/EURO Healthy Cities, perhaps because walking is not a priority in Phase V of the WHO/EURO Healthy Cities programme – nor in the SDGs at the global level. To investigate this hypothesis, we suggest a comparative study of policies on walking and on aspects of urban health that are recognised as priorities (tobacco-free cities, healthy food and diet) between European cities that do or do not participate in the WHO/EURO Healthy Cities programme

Challenges and Prospects for Integrating the Assessment of Health Impacts in the Licensing Process of Large Capital Project in Brazil

Brazil was one of the first countries in Latin America to institutionalize a National Environmental Policy in 1981, including the environmental impact assessment (EIA) process of economic activities with anticipated impacts on the environment. Today, EIA practice in Brazil comes with a number of limitations: it is constrained by its environmental advocacy role; application is strongly oriented towards large capital projects; and social responsibility considerations are only partially included. Consequently, EIA studies mainly address issues connected to localised and direct environmental impacts, largely ignoring any socio-economic and health impacts. This perspective paper highlights limitations of current EIA practice in Brazil with a focus on health considerations in impact assessment. While recognizing the positive impact to municipalities where large capital projects are being developed and operated, adverse impacts on health are a reality with measurable evidence in Brazil. Therefore, we argue that specificities on how to systematically assess and monitor potential health impacts cannot remain invisible in the Brazilian legislation, as currently seen in the reformulation of the licensing process in the country. The process of better integrating the assessment of health impacts in the licensing process of large capital project in Brazil must, however, not be based on the imposition of an external model but should be promoted by internal stakeholders from the environmental and health sector, incorporating the experiences gained in various case studies from all over the countr

Challenges and Prospects for Integrating the Assessment of Health Impacts in the Licensing Process of Large Capital Project in Brazil

Abstract Brazil was one of the first countries in Latin America to institutionalize a National Environmental Policy in 1981, including the environmental impact assessment (EIA) process of economic activities with anticipated impacts on the environment. Today, EIA practice in Brazil comes with a number of limitations: it is constrained by its environmental advocacy role; application is strongly oriented towards large capital projects; and social responsibility considerations are only partially included. Consequently, EIA studies mainly address issues connected to localised and direct environmental impacts, largely ignoring any socio-economic and health impacts. This perspective paper highlights limitations of current EIA practice in Brazil with a focus on health considerations in impact assessment. While recognizing the positive impact to municipalities where large capital projects are being developed and operated, adverse impacts on health are a reality with measurable evidence in Brazil. Therefore, we argue that specificities on how to systematically assess and monitor potential health impacts cannot remain invisible in the Brazilian legislation, as currently seen in the reformulation of the licensing process in the country. The process of better integrating the assessment of health impacts in the licensing process of large capital project in Brazil must, however, not be based on the imposition of an external model but should be promoted by internal stakeholders from the environmental and health sector, incorporating the experiences gained in various case studies from all over the country

Int J Environ Res Public Health

This scoping study aims to explore the relationships between urban green spaces (UGSs) and the onset, remission and recovery of cancer. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (protocol published in 2018). Eligibility criteria for papers were: (1) to be concerned with UGSs, (2) reporting effects of UGSs on cancer-related outcomes including direct or indirect measures, (3) reporting randomized controlled trials, prospective cohort studies, case studies, observational studies, non-comparative studies, (4) in English or French. The search covered primary studies in the published and unpublished (grey) literatures searching by hand and electronic databases (MEDLINE, Green File, Cumulative Index to Nursing and Allied Health Literature and ScienceDirect). Among 1703 records screened by two reviewers independently, 29 were included for qualitative synthesis. We classify the cancers concerned and the effects reported i.e., protective effect, risk or without association. The most investigated cancers are bladder, breast and lung cancer. Our study also identified contributing factors and their mediating effects between UGSs and cancer. Even though the strength of the evidence of the associations between UGSs and cancer is still weak due to the low number of studies and their design, results highlight the wide variety of possible mediating factors between the use of green spaces and cancer occurrence, remission and/or prevention. Knowledge gaps and future research perspectives should be oriented to qualitative research on protective factors with an attention to equity in UGS access and use

Healthy Cities Phase V evaluation: further synthesizing realism

In this article we reflect on the quality of a realist synthesis paradigm applied to the evaluation of Phase V of the WHO European Healthy Cities Network. The programmatic application of this approach has led to very high response rates and a wealth of important data. All articles in this Supplement report that cities in the network move from small-scale, time-limited projects predominantly focused on health lifestyles to the significant inclusion of policies and programmes on systems and values for good health governance. The evaluation team felt that, due to time and resource limitations, it was unable to fully exploit the potential of realist synthesis. In particular, the synthetic integration of different strategic foci of Phase V designation areas did not come to full fruition. We recommend better and more sustained integration of realist synthesis in the practice of Healthy Cities in future Phase