Health impact assessment (HIA) and health in environmental assessments – Enhancing HIA practice in Portugal

Este documento tem co-autoria da Unidade de Promoção da Saúde, Departamento de Promoção da Saúde e Prevenção de Doenças Não Transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, IP, LisboaTo further support development of HIA in Portugal, the Ministry of Health of Portugal together with the National Health Institute of Doctor Ricardo Jorge initiated organization of a workshop within the Biennial Collaborative Agreement (BCA) with WHO EURO office in Bonn, Germany. The workshop convened in Lisbon, at the National Health Institute of Doctor Ricardo Jorge on November 13-15, 2017.Aim and objectives of the workshop: The importance of assessing the health implications of policies, plans, programmes and projects of different sectors has been long established. Through the Health 2020 approach, the European framework on health, adopted in 2012 by the Member States in the WHO European Region, the need for a whole‐of‐government and whole‐of‐society approach has been re‐emphasised. Within this approach health impact assessment (HIA) can play a crucial role by supporting decision‐makers inand outside of the health sector to address health impacts and inequalities, and ensure the health of future generations through the identification and estimation of possible impacts of proposed policies and activities. HIA can thus play an important role in achieving the Sustainable Development Goals (SDGs). The Ministry of Health of Portugal through its Directorate General is in the process of proposing a new Government Bill (nr 49/XIII) that defines the competencies of the Public Health Services. These competencies include among others the assessment of potential health impacts of proposed legislative acts. Therefore an implementation model for HIA in Portugal is proposed by the Committee for the National Public Health Reform to assess in a first step, policies of any sector and their potential impacts on health and well‐being. Through the implementation of HIA of policies, as well as of plans, programs and projects there is great potential for health gains. Several Member States in the WHO European Region have already established legal obligations for HIA but in the majority of countries HIAs are voluntarily conducted. Meanwhile, in many countries, including Portugal, legal obligations for environmental assessments exist which include the need to assess impacts on human health and on the population, as for example defined in the European Directives on Environmental Impact Assessment (EIA Directive 2014/52/EU) and on Strategic Environmental Assessment (SEA Directive 2001/42/EC) as well as the Espoo Convention on EIA in a Transboundary Context and its Protocol on SEA of the United Nations Economic Commission for Europe (UNECE). Public health authorities need to be prepared not only to assess the impacts of policies, plans, programs and projects of the health sector but also to engage in environmental assessments. To further support development of HIA in Portugal, the Ministry of Health of Portugal together with the National Health Institute of Doctor Ricardo Jorge initiated organization of a workshop within the Biennial Collaborative Agreement (BCA) with WHO EURO office in Bonn, Germany. The workshop convened in Lisbon, at the National Health Institute of Doctor Ricardo Jorge on November 13-15, 2017.Este relatório resume as discussões e principais conclusões do Workshop realizado em Lisboa, dias 13-15 de Novembro de 2017, no âmbito do BCA para Portugal (BCA 2016-2017), sobre desenvolvimento da cultura de HIA em Portugal. A reunião foi tecnicamente apoiada pela OMS – Europa.info:eu-repo/semantics/publishedVersio

Developing a model to estimate the potential impact of municipal investment on city health

This article summarizes a process which exemplifies the potential impact of municipal investment on the burden of cardiovascular disease (CVD) in city populations. We report on Developing an evidence-based approach to city public health planning and investment in Europe (DECiPHEr), a project part funded by the European Union. It had twin objectives: first, to develop and validate a vocational educational training package for policy makers and political decision takers; second, to use this opportunity to iterate a robust and user-friendly investment tool for maximizing the public health impact of 'mainstream' municipal policies, programs and investments. There were seven stages in the development process shared by an academic team from Sheffield Hallam University and partners from four cities drawn from the WHO European Healthy Cities Network. There were five iterations of the model resulting from this process. The initial focus was CVD as the biggest cause of death and disability in Europe. Our original prototype 'cost offset' model was confined to proximal determinants of CVD, utilizing modified 'Framingham' equations to estimate the impact of population level cardiovascular risk factor reduction on future demand for acute hospital admissions. The DECiPHEr iterations first extended the scope of the model to distal determinants and then focused progressively on practical interventions. Six key domains of local influence on population health were introduced into the model by the development process: education, housing, environment, public health, economy and security. Deploying a realist synthesis methodology, the model then connected distal with proximal determinants of CVD. Existing scientific evidence and cities' experiential knowledge were 'plugged-in' or 'triangulated' to elaborate the causal pathways from domain interventions to public health impacts. A key product is an enhanced version of the cost offset model, named Sheffield Health Effectiveness Framework Tool, incorporating both proximal and distal determinants in estimating the cost benefits of domain interventions. A key message is that the insights of the policy community are essential in developing and then utilising such a predictive tool

Measuring activities in tobacco control across the EU. The MAToC

BACKGROUND: Objectives of this study are (a) to develop a comprehensive and economic tool to estimate tobacco control (TC) activities in single EU member states, (b) to compare TC activities between member states of the EU. This article provides the questionnaire and gives a benchmark of EU member states according to their perceived TC activities. Methods: An international workshop was specifically initiated to develop the questionnaire "Measuring Activities in Tobacco Control (MATOC)". TC experts from 8 European countries participated and chose 40 items to cover 11 general topics of TC. At the World Conference of Tobacco or Health in Helsinki 2003 participants were asked to fill out the questionnaire. N = 142 participants from EU-member states returned questionnaires. RESULTS: Subjects from the tobacco field in Finland gave the highest TC values to their country, followed by Sweden, Ireland, the UK and the Netherlands. The least active countries in TC were Greece and Germany, behind Austria, Spain, Belgium and Portugal. Italy, France and Denmark constituted the middle field. CONCLUSION: The MATOC provides a profile of TC across European countries and delivers results that are plausible and fit into the existing findings. The data presented here fulfils the purpose to illustrate what is possible with the MATOC and underlines the value of such an approach in delivering information for policy makers and TC advocates how TC is perceived in each country. Yet, further validity testing is necessary, the number of experts per country differs and is partly rather small. Further research with the MATOC should encounter these limitations. The procedure though could serve as model of practice for alcohol and legal drug policy as well

'I think that it's a pain in the ass that I have to stand outside in the cold and have a cigarette': representations of smoking and experiences of disapproval in UK and Greek smokers

Smokers in Greece and the UK are habitually exposed to different levels of social disapproval. This qualitative study explored the accounts of smoking and disapproval offered by 32 UK and Greek smokers. Accounts were framed with reference to a highly moralized construction of smoking. Participants were sensitive to social disapproval of their smoking. While disapproval from those close to them was accepted, disapproval from the general public was not. Two discursive repertories 'smoking works for me now' and 'the struggle to quit' were identified as resources that participants drew upon to enable continued smoking while acknowledging the health issues. While there were many similarities in the accounts provided, there were important differences that seem to reflect the different 'smoking worlds' inhabited. Copyright 2006 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution

Trends in drinking habits among adolescents in the Baltic countries over the period of transition: HBSC survey results, 1993–2002

BACKGROUND: The Baltic countries – Estonia, Latvia, and Lithuania – are considered to be an example of regional homogeneity over the period of transition. The World Health Organization cross-national study on Health Behavior in School-aged Children (HBSC) allows a comparison and time trends analysis of behavioral patterns among adolescents in this region. The aim of this study was to estimate the prevalence and trends of alcohol consumption and drunkenness among adolescents of Estonia, Latvia, and Lithuania in 1993/94, 1997/98, and 2001/02. METHODS: Representative samples of 5286 boys and 6485 girls aged 15 from Estonia, Latvia, and Lithuania were surveyed in 1993/94, 1997/98, and 2001/02 school-year within the framework of HBSC study. The standardized survey methods were applied. The research focused on the following outcome variables: i) frequency of drinking beer, wine, and spirits; and ii) frequency of drunkenness. The same wording of questions on the consumption of alcohol was retained in each survey. RESULTS: Beer was the most frequently used alcoholic beverage across the Baltic countries among adolescents. The rate of weekly drinking of any alcoholic beverage increased considerably during the eight years of observation, especially among Estonian and Lithuanian students. In 2001/02, 25% of boys and 12.5% of girls have reported drinking alcohol at least weekly. The rate of regular alcohol drinking was two times higher in boys, while irregular drinking was more prevalent in girls. Two or more episodes of drunkenness in the lifespan were reported by 30% of boys and 15% of girls in 1993/94 and by 52% of boys and 36% of girls in 2001/02. The use of alcoholic beverages was related to the perceived family wealth: the students from the families perceived by them as wealthy were more likely to drink weekly as compared to the students from the families perceived by them as not wealthy. CONCLUSION: Over the period between 1993 and 2002 the prevalence of alcohol consumption among adolescents increased considerably across the Baltic countries. The efforts of dealing with this problem should employ a combination of measures, including the strategies relevant for the period of transition

'I think that it's a pain in the ass that I have to stand outside in the cold and have a cigarette': representations of smoking and experiences of disapproval in UK and Greek smokers

Smokers in Greece and the UK are habitually exposed to different levels of social disapproval. This qualitative study explored the accounts of smoking and disapproval offered by 32 UK and Greek smokers. Accounts were framed with reference to a highly moralized construction of smoking. Participants were sensitive to social disapproval of their smoking. While disapproval from those close to them was accepted, disapproval from the general public was not. Two discursive repertories 'smoking works for me now' and 'the struggle to quit' were identified as resources that participants drew upon to enable continued smoking while acknowledging the health issues. While there were many similarities in the accounts provided, there were important differences that seem to reflect the different 'smoking worlds' inhabited. Copyright 2006 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution

Health care reform and job satisfaction of primary health care physicians in Lithuania

BACKGROUND: The aim of this research paper is to study job satisfaction of physicians and general practitioners at primary health care institutions during the health care reform in Lithuania. METHODS: Self-administrated anonymous questionnaires were distributed to all physicians and general practitioners (N = 243, response rate – 78.6%), working at Kaunas primary health care level establishments, in October – December 2003. RESULTS: 15 men (7.9%) and 176 women (92.1%) participated in the research, among which 133 (69.6%) were GPs and 58 (30.4%) physicians. Respondents claimed to have chosen to become doctors, as other professions were of no interest to them. Total job satisfaction of the respondents was 4.74 point (on a 7 point scale). Besides 75.5% of the respondents said they would not recommend their children to choose a PHC level doctor's profession. The survey also showed that the respondents were most satisfied with the level of autonomy they get at work – 5.28, relationship with colleagues – 5.06, and management quality – 5.04, while compensation (2.09), social status (3.36), and workload (3.93) turned to be causing the highest dissatisfaction among the respondents. The strongest correlation (Spearmen's ratio) was observed between total job satisfaction and such factors as the level of autonomy – 0.566, workload – 0.452, and GP's social status – 0.458. CONCLUSION: Total job satisfaction of doctors working at primary health care establishments in Lithuania is relatively low, and compensation, social status, and workload are among the key factors that condition PHC doctors' dissatisfaction with their job

Numerical and experimental investigation of a lightweight bonnet for pedestrian safety

A topic of great consideration in current vehicle development in Europe is pedestrian protection. The enforcement of a new regulation trying to decrease the injuries to head, pelvis, and leg of pedestrian impacted by cars, is imposing great changes in vehicles' front design. In the present work a design solution for the bonnet, which is the main body part interacting with the human head during a car to pedestrian collision, is proposed. This solution meets the stiffness and safety targets, takes into account the manufacturing and recyclability requirements and gives a relevant contribution to vehicle lightweight. Thus this proposed solution puts in evidence that safety and lightweight are not incompatible targets. The amount of potential injury to the pedestrian head is evaluated, as prescribed by the standard test procedures, by means of a headform launched on the bonnet. However, the standard approach based on the head injury criterion (HIC) value only is reported to be largely unsatisfactory: therefore, a new experimental methodology for the measurement of the translational and the rotational accelerations has been developed, and the experimental results are reported. This would be a starting point for the evolution of currently adopted injury criteria to increase the safety of the vulnerable road user

Fungal DNA, allergens, mycotoxins and associations with asthmatic symptoms among pupils in schools from Johor Bahru, Malaysia.

While there is a large variation of prevalence of asthma symptoms worldwide, what we do know is that it is on the rise in developing countries. However, there are few studies on allergens, moulds and mycotoxin exposure in schools in tropical countries. The aims were to measure selected fungal DNA, furry pet allergens and mycotoxins in dust samples from schools in Malaysia and to study associations with pupils' respiratory health effects. Eight secondary schools and 32 classrooms in Johor Bahru, Malaysia were randomly selected. A questionnaire with standardized questions was used for health assessment in 15 randomly selected pupils from each class. The school buildings were inspected and both indoor and outdoor climate were measured. Dust samples were collected by cotton swabs and Petri dishes for fungal DNA, mycotoxins and allergens analysis. The participation rate was 96% (462/480 invited pupils), with a mean age of 14yr (range 14-16). The pupils mostly reported daytime breathlessness (41%), parental asthma or allergy (22%), pollen or pet allergy (21%) and doctor-diagnosed asthma (13%) but rarely reported night-time breathlessness (7%), asthma in the last 12months (3%), medication for asthma (4%) or smoking (5%). The inspection showed that no school had any mechanical ventilation system, but all classrooms had openable windows that were kept open during lectures. The mean building age was 16yr (range 3-40) and the mean indoor and outdoor CO2 levels were 492ppm and 408ppm, respectively. The mean values of indoor and outdoor temperature and relative humidity were the same, 29°C and 70% respectively. In cotton swab dust samples, the Geometric Mean (GM) value for total fungal DNA and Aspergillus/Penicillium (Asp/Pen) DNA in swab samples (Cell Equivalents (CE)/m2) was 5.7*108 and 0.5*108, respectively. The arithmetic mean (CE/m2) for Aspergillus versicolor DNA was 8780, Stachybotrys chartarum DNA was 26 and Streptomyces DNA was 893. The arithmetic means (pg/m2) for the mycotoxins sterigmatocystin and verrucarol were 2547 and 17, respectively. In Petri dish dust samples, the GM value for total fungal DNA and Asp/Pen DNA (CE/m2 per day) was 9.2*106 and 1.6*106, respectively. The arithmetic mean (CE/m2 per day) for A. versicolor DNA was 1478, S. chartarum DNA was 105 and Streptomyces DNA was 1271, respectively. The GM value for cat(Fel d1) allergen was 5.9ng/m2 per day. There were positive associations between A. versicolor DNA, wheeze and daytime breathlessness and between Streptomyces DNA and doctor-diagnosed asthma. However, the associations were inverse between S. chartarum DNA and daytime breathlessness and between verrucarol and daytime breathlessness. In conclusion, fungal DNA and cat allergen contamination were common in schools from Malaysia and there was a high prevalence of respiratory symptoms among pupils. Moreover, there were associations between levels of some fungal DNA and reported respiratory health in the pupils