You are on page 1of 56

HIA for increasing healthy life expectancy and well-being

4
:
:2012109()~11()
:
http://hia.kihasa.re.kr/eng
1005_ 2012-10-08 5:17 1
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera)
1005_ 2012-10-08 5:17 2
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
3
Welcoming remark
I am pleased to invite you to the Fourth Asia-Pacific HIA Conference, which will be held
October 9~11, 2012, in Seoul.
Governments around the world have of late increasingly employed HIA as a useful tool to
predict the health effects of policies and programs. HIA is also effective in addressing health
disparity issues including unequal distributions of health effects across groups of differ-
ent socioeconomic backgrounds. The Conference will focus on, among many other things,
the how HIA can be instrumental to increasing people's healthy life expectancy and well-
being.
During the conference, the Thematic Working Group on Health Impact Assessment will also
be holding its Fourth Meeting, to discuss HIA issues and to report on the progress of the
Workplan 2010-2012.
I sincerely hope that you will join us at the Conference and enrich the discussion with your
perspectives and insights.
Dr. Byong-ho Tchoe
President, KIHASA
1005_ 2012-10-08 5:17 3
4
| Korea Institute for Health and Social Affairs, Seoul, Korea
A. Date : October 9-11, 2012
B. Venue : Korea Institute for Health and Social Affairs, Seoul, Korea
C. Background
With the tool of Health Impact Assessment we can prevent diseases and injuries in a community and country
by providing recommendation for healthy public policy in development projects, programs and policies.
Countries have increasingly implemented HIA recently, because HIA is a useful tool to protect health by pre-
dicting the positive and negative health effects of a policy, a plan, a program, or a project and by recommending
proper measures to enhance the positive health effects and to minimize the negative health effect. HIA also
addresses health disparity issues including unequal distributions of health effects on people with different socioe-
conomic backgrounds.
While many countries have exerted efforts to implement HIA in the region, there exist some challenges in the
practice of HIA. We need some clear mechanism in institutionalization of HIA and guidelines with standardized
methodology and tools that can be utilized in different sectors. We need more evidence for the HIA practice in
the region, because many sources of evidence have come from the Western countries. Capacity building and
training are another important issue in the region. We need technical support and investment for HIA as well.
D. Aim of the Conference
The 4
th
Asia Pacific Regional Conference is to provide an opportunity for sharing knowledge with regard to
evidence based HIA practices, and to promote wide range of implementation of HIA in different sectors.
Hopefully, this conference can increase the opportunity for investment in HIA in the region.
E. Theme of the Conference
HIA for increasing healthy life expectancy and well-being
Key Themes in HIA
- Determinants of health and healthy lifestyles
- Equity oriented HIA
- Evidence based approach
- Practice of HIA : barriers and challenges
- Capacity building and training
- Institutionalization of HIA
- Evaluation of HIA
- International cooperation
Related issues in HIA
- Linking HIA with other forms of impact assessment
- Development projects and investment
- Natural disaster
- Climate change
- Other environmental issues
- Aging population and global burden of diseases
- Participatory approach
F. Organizing committee
- Conference organizing committee : Dr. Eun Jin Choi and KIHASA researchers, Dr. Eun Jeong
Kang(SoonChunHyang Univ), Dr. Young Soo Lee(KEI), Yoo Geun Heag(MOHW), Hyen Mi Chung(WPRO)
Conference information
1005_ 2012-10-08 5:17 4
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
5
Conference Information
a.m.
(9:30-12:30)
Lunch
(12:30-01:30)
p.m.
(1:30-05:00)
9 Oct. (Tuesday) 10 Oct. (Wednesday) 11 Oct. (Thursday)
Opening ceremony(09:30-10:00)
Plenary session(10:00-12:30)
Chair: Dr. Yoon hyung Park (Soonchunhyang University)
Recent developments in HIA a high-level overview
of HIA in a global context
(Michaela Pfeiffer, WHO)
Challenges to implementing HIA: ADB Perspective
(Genandrialine Peralta, ADB)
Health Impact Assessment, a process of harnessing
wisdom or squeezing in data?
(Domyung Paek, Seoul National University)
Health Impact Assessment in England(I)
(John Kemm, JK Public Health Consulting)
Growing the Field of Health Impact Assessment in the
United States: A Status Report
(Andrew L. Dannenberg, University of Washington)
KIHASA
Scientific session(01:30-05:00)
Chair : Dr. Yun-Chul Hong(Seoul National University)
The RAPID guidance; a tool for policy oriented HIA
(Gabriel Gulis, University of Southern Denmark)
Application of Exposure Science and Risk Assessment
in HIA
(Kiyoung Lee, Seoul National University)
HIA in ASEAN Community
(Tanita Suwanakitti, National Health Commission Office)
Training and capacity building of different implemen-
tation models in three Danish local municipalities
(Peter Gry, University of Southern Denmark)
Impact of electrification on human health evidence
from rural Bhutan
(Ganesh P. Rauniyar, ADB)
Embed Health Impact Assessment into Free Trade
Negotiation Processes
(Nusaraporn Kessomboon, Khon Kaen University)
The Need and Readiness for Health Impact
Assessment of the Organizations in Thailand
(Phen Sukmag, Prince of Songkla University)
Community Based Project Management: a Promising
Approach for Alleviating Sub Standard Neighborhood
in Indonesia
(Ansawi Manafl, Diponegoro University)
Multisectoral Participatory Approach for Health
Impact Assessment in Cambodia
(Prak Raingsey, Ministry of Health, Cambodia)
Determination of Environmental Factors that
Influenced Cholera Outbreak in Catanduanes
Province, Philippines
(Ms. Maia Sonabel Anarna, Department of Health,
Philippines)
Gala dinner at 6:00
Plenary session(9:30-10:30)
Chair : Dr. Hisashi Ogawa
(Former regional advisor, WHO WPRO)
Health, EIA, and major projects: working towards more inte-
grated approaches
(Richard Morgan, University of Otago)
Health Impact Assessment: Triumph over common sense?
(Ben Harris-Roxas, University of New South Wales)
Health Impact Assessment in England (II) Some points of
debate
John Kemm(JK Public Health Consulting)
Regional seminar
Chair : Dr. Hyenmi Chung(WHO W PRO)(10:40-12:30)
Health Impact Assessment Capacity Development in Vietnam
(Nguyen Thi Lien Huong, Ministry of Health, Vietnam)
Integration of HIA into the EIA report in Vietnam
(PHAM Hoai Nam, Ministry of Natural Resources and
Environment, Vietnam)
Is HIA Effective for Top Level Administrative Plan?
(Young Soo Lee, KEI)
The potential health effects of climate change on the elderly
population in Korea
(Yoon Shin Kim, Hanyang University)
Health Impact Assessment in Healthy Cities in Korea
(Dongjin Kim, KIHASA)
Using community knowledge in promoting health: Examples
from two case studies in Seoul
(Jinhee Kim, Seoul National University)
KIHASA
Regional Seminar
Chair : Dr. Hisashi Ogawa
(Former regional advisor, WHO WPRO)
Health Impact Assessment in China
(Jin Yinlong, IEHRP, China)
Health Impact Assessment in Mongolia
(Tsetsegsaikhan B., Ministry of Health, Mongolia)
Health in EIA : Thailands Experiences
(Siriwan Chandanachulaka, Ministry of Public Health, Thailand)
HIA on Dam Construction in Korea
(Young Soo Lee, KEI)
Scientific session
Chair : Dr. Hyenmi Chung(WHO WPRO)
Health Impact Assessment of Settlement Re-developement:
A Case from Low-income Area of Small City in South Korea
(Kwang Wook Koh, Kosin University)
The Experience of Health Impact assessment of Immunization
Program in Jinju City, Korea
(Keon Yeop Kim, Kyungpook National University)
Association of Part-Time Work and Suicide Attempts among
Korean Adolescent Students: a National Cross-Sectional
Survey
(Sun-Jin Jo, Catholic University of Korea)
The Impact of Socioeconomic Environment on Local Suicide
Mortality: Evidence from a Spatial Analysis
(Eunjeong Kang, Soonchunhyang University)
Bacterial and Fungal Profile and Antimicrobial Susceptibility
Pattern from Patients of Chronic Suppurative Otitis Media
with Special Emphasis on Seasonal Variation at Civial Hospital
Karachi Pakistan
(Maria Shoaib, Dow University of Health Sciences)
TWG Business
Meeting
(9:30-12:30)
Chair : Dr. Eun Jin
Choi(KIHASA)
(1:30-3:30)
Expert meeting
&
Closing of the conference
KIHASA
1005_ 2012-10-08 5:17 5
6
| Korea Institute for Health and Social Affairs, Seoul, Korea
Country Name Affiliation
Dr Prak Piseth Raingsey
Dr. Jin Yinlong

Mrs. Vilayvone MANGKHASEUM
Dr. Tsetsegsaikhan B.
Ms. Maria Sonabel Anarna
Dr. Eun Jin Choi
Dr. Young Soo Lee
Ms. Siriwan Chandanachulaka
Dr. Nguyen Thi Lien Huong
Dr. PHAM Hoai Nam
Cambodia
China
Lao People's Democratic Republic
Mongolia
Philippines
Republic of Kroea
Thailand
Vietnam
Vietnam
Ministry of Health
Institute for Environmental Health and
Related Product Safety
Ministry of Health
Ministry of Health
Department of Health
KIHASA
KEI
Ministry of Public health
Ministry of Health of Vietnam
Ministry of Natural Resources and
Environment
Participants
Dr. Nasir Hassan (Team Leader-Environmental Health, Building Healthy Communities & Population, WHO WPRO)
Dr. Hisashi Ogawa (Former Regional advisor, WHO WPRO)
Dr. CHUNG Hyenmi (Technical Officer, Environmental Health Team, WHO WPRO)
Dr. Michaela Pfeiffer (Technical Officer, WHO)
Dr. Genandrialine L. Peralta (SeniorSafeguardsSpecialist(Environment), Asian Development Bank)
Dr. John Kemm (Public Health Consulting Ltd., UK)
Dr. Gabriel Gulis (Univ. of Southern Denmark)
Dr. Andy Dannenberg (Affiliate Professor, University of Washington, CDC, USA)
Dr. Richard Morgan (Univ. of Otago, New Zealand)
Dr. Ben Harris-Roxas (Harris-Roxas Health, Australia)
Thematic Working Group on Health Impact Assessment
Korean Speakers
-()
(EunjeongKang,MPH,Ph.D.;AssistantProfessor;SoonchunhyangUniversity,DepartmentofHealthAdministration
andManagement)
-()
(KwangWookKoh,MD,Ph.D.;Professor:KosinUniversityCollegeofMedicine,GraduateSchoolofPublicHealth)
-()
(KeonYeopKim,MD,Ph.D.;Professor:KyungpookNationalUniversitySchoolofMedicine)
-()
(DongjinKim,Dr.PH;AssociateResearchFellow:KoreaInstituteforHealthandSocialAffairs)
-()
(YoonShinKim,MPH,DrHSc,PhD;Professor:HanyangUniversity,CollegeofMedicine,Dept.ofOccupational
&EnvironmentalMedicine)
1005_ 2012-10-08 5:17 6
The 4
th
Asia and Pacific Racific Regional Health Impact Assessment Conference(Seoul, Koera) |
7
-()
(JinheeKim,MPH;PhDCandidate,SeoulNationalUniversity)
-()
(EunWooNam,MPH,Ph.D.;Professor:YonseiUniversityCollegeofHealthSciences)
-()
(YoonhyungPark,MD.Ph.D.;Professor:SoonchunhyangUniversity,CollegeofMedicine,Departmentof
Preventivemedicine)
-()
(DomyungPaek,MD,MSc,ScD:Professor:SeoulNationalUniversityGraduateSchoolofPublicHealth)
-()
(KiyoungLee,ScD,CIH;Professor:SeoulNationalUniversityGraduateSchoolofPublicHealth)
-()
(YoungSooLee,Ph.D.;SeniorResearchFellow:KoreaEnvironmentInstitute)
-()
(Sun-JinJo,MPH,PH.D.;ResearchAssistantProfessor:TheCatholicUniversityofKoreaCollegeofMedicine)
-()
(EunJinChoi,Ph.D.;ResearchFellow:KoreaInstituteforHealthandSocialAffairs)
-()
(Yun-ChulHongMD,Ph.D;Professor:SeoulNationalUniversityCollegeofMedicine)
Keynote Speech Themes
Recent developments in HIA a high-level overview of HIA in a global context
(Pfeiffer, Michaela, World Health Organization, Geneva, Switzerland)
Challenges to implementing HIA: ADB Perspective
(Genandrialine Peralta, Patricia Moser, Asian Development Bank, Manila, Philippines)
The RAPID guidance; a tool for policy oriented HIA
(Gabriel Gulis, University of Southern Denmark, Esbjerg, Denmark)
HIA News from the West
(John Kemm, M.A., M.D., F.F.C.M., F.R.C.P., United Kingdom)
Health Impact Assessment, a process of harnessing wisdom or squeezing in data?
(Domyung Paek, Seoul National University, Seoul, Korea)
Health, EIA, and major projects: working towards more integrated approaches
(Richard K. Morgan, Professor, Department of Geography, University of Otago, Dunedin, New Zealand.)
Health Impact Assessment: Triumph over common sense?
(Ben Harris-Roxas, Conjoint Lecturer, Centre for Primary Health Care and Equity, University of New South Wales, Australia;
Consultant, Harris-Roxas Health; Health Section Co-Chair, International Association for Impact Assessment)
1005_ 2012-10-08 5:17 7
8
| Korea Institute for Health and Social Affairs, Seoul, Korea
Growing the field of Health Impact Assessment in the United States: A Status Report
(Andrew L. Dannenberg, MD, MPH, University of Washington & National Center for Environmental Health, Centers for Disease
Control and Prevention, U.S.A.)
Application of Exposure Science and Risk Assessment in HIA
(Kiyoung Lee,Seoul National University, Seoul, Korea)
Health Impact Assessment in Healthy Cities in Korea
(Dongjin Kim, Korea Institute for Health and Social Affairs, Seoul, Korea)
Is HIA Effective for Top Level Administrative Plan?
(Young Soo Lee, Korea Environment Institute, Seoul, Korea)
Scientific Sessions and presenters
Bacterial and Fungal Profile and Antimicrobial Susceptibility Pattern from Patients of Chronic Suppurative Otitis
Media in Civil Hospital Karachi (C.H.K.);
(Maria Shoaib, Dow University of Health Sciences, Karachi, Pakistan)
Estimating the effect of health state on intergenerational poverty in Senegal
(Hounkpodote Hilaire Guy Adetona, University Cheikh Anta Diop of Dakar (UCAD), Dakar, Senegal)
Training and capacity building of different implementation models in three Danish local municipalities
(Peter Gry, University of Southern Denmark, Esbjerg, Denmark)
Impact of electrification on human health evidence from rural Bhutan
(Ganesh P. Rauniyar, Asian Development Bank, Metro Manila, Philippines)
Entrench Health Impact Assessment into Free Trade
(Kessomboon Nusaraporn, Khon Kaen University, Thailand)
HIA in ASEAN Community
(Suwanakitti Tanita, National Health Commission Office, Bangkok, Thailand
The Need and Readiness for Health Impact Assessment of the Organizations in Thailand
(Phen Sukmag, Prince of Songkla University, Songkla, Thailand)
Community Based Project Management: a Promising Approach for Alleviating Sub Standard Neighborhood
in Indonesia
(Dr. Ing. Asnawi Diponegoro University, Semarang, Indonesia)
The Impact of Socioeconomic Environment on Local Suicide Mortality: Evidence from a Spatial Analysis
(Eunjeong Kang, Soon Chun Hyang University, Asan, Korea)
Association of Part-Time Work and Suicide Attempts among Korean Adolescent Students: a National Cross-
Sectional Survey
(Sun-Jin Jo, Department of Preventive Medicine, College of Medicine, the Catholic University of Korea, Seoul, Korea)
Using community knowledge in promoting health: Examples from two case studies in Seoul
(Jinhee Kim, Graduate School of Public Health, Seoul National University, Seoul, Korea)
The potential health effects of climate change on the elderly population in Korea
(Yoon Shin Kim, Hanyang University, Seoul, Korea)
Health Impact Assessment of Settlement Re-developement: A Case from Low-income Area of Small City in
South Korea
(Kwang Wook Koh, Kosin University, Busan, Korea)
The Experience of Health Impact assessment of Immunization Program in Jinju City, Korea
(Keon Yeop Kim, Kyungbuk University, Daegu, Korea)
HIA on Dam Construction in Korea
(Young Soo Lee, Korea Environment Institute, Seoul, Korea)
1005_ 2012-10-08 5:17 8
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
9
Summary of speech and
abstracts
http://hia.kihasa.re.kr/eng
T
h
e

4
t
h
A
s
i
a

a
n
d

P
a
c
i
f
i
c

R
e
g
i
o
n
a
l

H
e
a
l
t
h

I
m
p
a
c
t

A
s
s
e
s
s
m
e
n
t

C
o
n
f
e
r
e
n
c
e
(
S
e
o
u
l
,

K
o
e
r
a
)

1005_ 2012-10-08 5:17 9
Contents
Recent developments in HIA a high-level overview of HIA in a global context ___________________________________________________ 11
Challenges to implementing HIA: ADB Perspective _____________________________________________________________________________ 13
Health Impact Assessment Practice in England (9
th
October 2012)_______________________________________________________________ 15
Health Impact Assessment in England Some topics of debate (10
th
October 2012) _______________________________________________ 16
Growing the Field of Health Impact Assessment in the United States: A Status Report ____________________________________________ 17
The RAPID guidance; a tool for policy oriented HIA ____________________________________________________________________________ 19
Health, EIA, and major projects: working towards more integrated approaches.___________________________________________________ 20
Health Impact Assessment: Triumph over common sense? _____________________________________________________________________ 23
BACTERIAL AND FUNGAL PROFILE AND ANTIMICROBIAL SUSCEPTIBILITY PATTERN FROM PATIENTS OF CHRONIC
SUPPURATIVE OTITIS MEDIA WITH SPECIAL EMPHASIS ON SEASONAL VARIATION AT CIVIL HOSPITAL KARACHI PAKISTAN. ____ 25
Estimating the effect of health state on intergenerational poverty in Senegal ____________________________________________________ 26
Training and capacity building of different implementation models in three Danish local municipalities ______________________________ 27
Impact of electrification on human health evidence from rural Bhutan __________________________________________________________ 28
Embed Health Impact Assessment into Free Trade Negotiation Processes _______________________________________________________ 29
HIA in ASEAN Community ___________________________________________________________________________________________________ 30
The Need and Readiness for Health Impact Assessment of the Organizations in Thailand.__________________________________________ 31
Community Based Project Management: a Promising Approach for Alleviating Sub Standard Neighborhood in Indonesia _____________ 32
Health Impact Assessment, a process of harnessing wisdom or squeezing in data? _______________________________________________ 33
Application of Exposure Science and Risk Assessment in HIA ___________________________________________________________________ 34
Is HIA Effective for Top Level Administrative Plan? ____________________________________________________________________________ 35
HIA on Dam Construction in Korea ___________________________________________________________________________________________ 36
Health Impact Assessment in Healthy Cities in Korea __________________________________________________________________________ 37
Using community knowledge in promoting health: Examples from two case studies in Seoul _______________________________________ 38
The potential health effects of climate change on the elderly population in Korea _________________________________________________ 39
Health Impact Assessment of Settlement Re-developement: A Case from Low-income Area of Small City in South Korea ___________ 40
The Experience of Health Impact assessment of Immunization Program in Jinju City, Korea _______________________________________ 41
The Impact of Socioeconomic Environment on Local Suicide Mortality: Evidence from a Spatial Analysis ____________________________ 43
Association of Part-Time Work and Suicide Attempts among Korean Adolescent Students: a National Cross-Sectional Survey_______ 44
Health Impact Assessment Capacity Development in Vietnam __________________________________________________________________ 45
MultisectOral PARTICIPATORY APPROACH FOR HEALTH IMPACT ASSESSMENT IN CAMBODIA__________________________________ 47
Determination of Environmental Factors that Influenced Cholera Outbreak in Catanduanes Province, Philippines ____________________ 49
Health Impact Assessment in Mongolia _______________________________________________________________________________________ 50
Health in EIA : Thailands Experiences ________________________________________________________________________________________ 51
Integration of HIA into the EIA report in Vietnam ______________________________________________________________________________ 52
1005_ 2012-10-08 5:17 10
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
11
Recent developments in HIA a high-level overview of
HIA in a global context
This presentation will provide a high-level overview and perspective on recent developments in HIA
that could serve as a backdrop for some of the more detailed discussions about HIA methods,
experience and practice that will follow. HIA applications (and perspectives) will be described in four
contexts: 1) the global health arena; 2) Rio+20, sustainable development and a green economy; 3)
development finance and in particular in relation to environmental and social safeguards applied to
large infrastructure projects; and 4) in the context of building country capacities to respond to
specific demands posed by a particular industry. Regionally relevant examples are provided
where possible.
Following is an annotated outline of some of the main points that will be covered under each of the
four headings:
1. HIA in the global health arena: HIA is gaining renewed visibility as an instrument for health in all
policies (HiAP), tackling non-communicable diseases, and for addressing health equity gaps
through action on social determinants of health. Reference will be made to HIA expert meetings
and consultations including in Kobe (June 2012) and in Quebec (August 2012).
2. HIA in the context of sustainable development: Health is a prerequisite and measure of sustain-
able and equitable/fair development. In Rio+20 (June 2012) HIA was recognized as a key instru-
ment for integrating health into wider sustainable development/green economy policies and
investments and for monitoring and measuring the impact of these policies on human well-being.
Examples will be drawn from the findings of WHO research (using HIA tools and methods) on the
health risks and benefits associated with green policies proposed in three priority sectors: 1) urban
transport, 2) housing and the built environment; and 3) household energy.
3. HIA and development finance: Many multilateral financial institutions, such as the World Bank, its
private sector lending arm the International Finance Corporation (IFC), and regional development
banks like the Asian Development Bank, use environmental and social performance requirements or
safeguards to ensure that the projects they finance (e.g. dams) do not harm the environment and near-
by communities. In 2007, the IFC introduced a specific performance requirement for community health
and safety. Since then, WHO has been actively engaged with the banks to enhance coverage of pub-
lic health issues within their safeguard systems. HIA is the main instrument used to do this.
Pfeiffer, Michaela
1
1: World Health Organization, Geneva, Switzerland
1005_ 2012-10-08 5:17 11
12
| Korea Institute for Health and Social Affairs, Seoul, Korea
4. HIA as an instrument for strengthening country systems HIA applied at the sectoral or strate-
gic level (i.e. at the level of industry) can facilitater the identification of wider and cumulative health
impacts that result from multiple projects and activities. HIA, when applied at this level, can also
identify health systems services and capacities needed (e.g. chemical incident response) to respond
to those health issues if and when they arise. Examples and insights will be drawn from the pilot
that under-development in Mongolias mining sector.
Key words : Health impact assessment, Sustainable development, Health in all policies
Contact information:
Ms Michaela V Pfeiffer
Public Health and Environment Department
World Health Organization
20 Avenue Appia, CH-1211 Geneva 27
Switzerland
Phone: +41 22 791 2379
Fax: +41 22 791 1383
E-mail: pfeifferm@who.int
1005_ 2012-10-08 5:17 12
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
13
Challenges to implementing HIA: ADB Perspective
Through its Strategy 2020 (2008-2020), ADB
1
has five core specializations that best support its agen-
da: (i) infrastructure; (ii) environment, including climate change; (iii) regional cooperation and inte-
gration; (iv) financial sector development; and (v) education. To contribute to public health, ADB invests
in water, sanitation, waste management systems, rural infrastructure, covering irrigation and water
management, rural roads, and rural electrification. In urban infrastructure, ADB focuses on water sup-
ply, sanitation, waste management, and urban transport.
ADB works through the project cycle, from project identification, feasibility study, project prepara-
tion, project/loan processing, negotiations, approval, effectiveness then project implementation
with supervision, monitoring and reporting until completion and evaluation. Lessons are learned through-
out the project cycles which are fed into new projects as they are developed and implemented. Some
examples shall be provided on typical ADB-financed public sector infrastructure projects to illustrate
the various stages of the project cycle over time, and possibly illustrate how health impacts could be
considered at each stage.
There is an assumption that all development projects can improve human health. Currently ADB does
not take into account health benefits of a project in the calculation of EIRR, economic internal rate of
return. Presumably the inclusion of health benefits would raise the EIRR but the challenge is how to
do it, quickly and reasonably.
Within ADB, there is a polarity of thinking on the best approach to take on HIA - whether the safe-
guards approach or health optimization through infrastructure projects. Both are being practiced but
there is no agreement yet on which one works best. Infrastructure is the largest ADB sector comprising
70%of projects by volume, with the 30%accounted for the finance sector development and edu-
cation sector (combined with health, agriculture, and the other sectors). Through 70%infrastruc-
ture projects, ADB could make a difference in peoples health, through application of health impact
assessment (HIA), as part of environmental impact assessment (EIA), a requirement in project pro-
cessing. In this environmental assessment, a rapid environmental checklist is prepared at the begin-
ning of the project for environmental categorization (such as A, B, or C) and to allocate proper time
and resources on the assessment during project preparatory stage.
Genandrialine Peralta, Patricia Moser
Asian Development Bank, Manila, Philippines
1 The Asian Development Bank was founded in 1966 and it has its headquarters in Manila, Philippines. It now has 67 member countries
and 30 country offices with the mission to have an Asia and Pacific free from poverty (1.8 billion poor people are in this region). With
$22 billion in approved financing in 2011, more than 2,900 employees from 59 countries work towards fighting poverty in Asia and Pacific.
ADB provides loans, grants, policy dialogue, technical assistance and equity investments in both public and private sectors. It has a mul-
tidisciplinary staff consisting of economists, sociologists, engineers, gender and health experts, and environmental scientists.
1005_ 2012-10-08 5:17 13
14
| Korea Institute for Health and Social Affairs, Seoul, Korea
Specifically this is covered in the Safeguard Policy Statement (SPS 2009) which requires either an Initial
Environmental Examination (IEE) for Category B project or an Environmental Impact Assessment (EIA)
for Category A project. Health is considered with regards to protection of health of workers and com-
munities, i.e. (i) occupational health and safety and (ii) community health and safety. These are both
included in every IEE/EIA report. To comply with the SPS, Borrowers have to follow applicable
national and local regulatory requirements, relevant international conventions, as well as identify sig-
nificant environmental impacts and implement mitigation measures to reduce the potential impacts.
In addition, the Borrower conducts public consultations to engage and inform local communities, stake-
holders, civil societies and NGOs about the project and its potential impacts.
In the last 20 years, ADB published two HIA guidelines on development projects and programs where
identifying environmental impacts were seen to be important intermediate steps in the causation of
health impacts and their prevention or mitigation. In this case, EIA is actually part of HIA. The
International Finance Corporation already requires ESHIA or Environmental, Social, and Health
Impact Assessment. However, evidence based health impact assessments are still challenging to under-
take and this might be the reason why the World Bank and other regional banks including ADB have
not followed this approach towards ESHIA.
There are ways to consider health impacts with environmental impacts throughout the project cycle.
One suggestion is at the upstream stage, where project or site selection could be undertaken early
on for alternatives which have greater potential for producing health outcomes. This paradigm shift
might be a better approach rather than the safeguard approach. ADB works with other internation-
al financing institutions to harmonize and unify their requirements and alignment with country sys-
tems under the 2005 Paris Declaration on Aid Effectiveness and the Accra Agenda for Action.
Keywords: development projects, health impacts, EIA
Contact Information:
Dr. Genandrialine L. Peralta
Seniors Safeguards Specialist (Environment)
Southeast Asia Regional Department
Asian Development Bank
6 ADB Avenue, Mandaluyong City
1550 Metro Manila, Philippines
Tel: (632) 683-1726
Fax: (632) 636-2336
Email: gperalta@adb.org
Ms. Patricia Moser
Lead Health Specialist
Regional Sustainable Development Department
Asian Development Bank
6 ADB Avenue, Mandaluyong City
1550 Metro Manila, Philippines
Tel: (632) 632-6329
Fax: (632) 636-2336
Email: pmoser@adb.org
1005_ 2012-10-08 5:17 14
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
15
Health Impact Assessment Practice in England (9
th
October 2012)
HIA is used to assist in making a decision and to predict the future consequences of choosing differ-
ent options. People may request an HIA because they want information on that decision or recom-
mendations on how to implement the decision. More frequently and less properly they may request
an HIA to demonstrate that the decision they have already taken is right or to oppose or support a
particular decision. The main benefits of an HIA are an informed decision allowing the decision
maker to make better trade offs between their various objectives and make decisions that are bet-
ter for health. Additional benefits are greater understanding between different disciplines and agen-
cies and greater understanding of health in the community.
Attempts to predict the future consequences of the various options may be based on epidemiology/
toxicology or on social sciences and participation. An epidemiologist attempts to estimate future expo-
sure levels and then use dose response curves to predict the consequences. This approach is easier
to apply to causal paths involving pollutants and noise than to other causes. Those who rely on par-
ticipation seek to assess the consequences by listening to the hopes and fears of those affected.
Full scoping is key to a successful HIA. This involves clarifying the decision and the boundaries to the
enquiry, identifying the stake holders, deciding the types of evidence to be used, considering the causal
pathways, the process for reporting and the type of HIA to be done. The final report should include
recommendations for mitigation, enhancement and monitoring.
HIA can also be used to improve (national) policy but when applied to policy HIA needs slightly dif-
ferent methods to HIA for projects.
Keywords: Benefits of HIA, Scoping HIA, Recommendation in HIA, HIA of Policy
John Kemm
JK Public Health Consulting, Bromsgrove, UK
1005_ 2012-10-08 5:17 15
16
| Korea Institute for Health and Social Affairs, Seoul, Korea
Health Impact Assessment in England Some topics of
debate (10
th
October 2012)
HIA has to attempt to describe the magnitude of impacts. Quantitative approaches attempt to do this
using numbers while qualitative approaches use ordinal scales in words. Lack of information and detailed
understanding of mechanisms make it rare for impacts to be successfully quantitated. Criteria must
be specified to make ordinal scales meaningful.
The Gothenburg consensus statement suggested values for HIA. Ethical use of evidence implies
impartiality. There is a temptation to use HIA as an advocacy tool but this raises problems and is not
compatible with impartiality. WHO and many national governments are trying to promote health equi-
ty and HIA can support this by describing the distribution of impacts.
Decision makers are now asked to undertake a wide range of impact assessments and this can
become a considerable work burden. There is therefore a strong case for integrating health impact
assessment with other impact assessments though this does carry the risk that health will be given
inadequate consideration. In England (and in the European Union) all policies are subject to an inte-
grated impact assessment which has to be published. At the moment health is not well covered in this
system but it is probably wiser to argue for an improvement of health coverage in the existing sys-
tem rather than to ask for additional HIA.
Key Words : Magnitude of impacts, Modelling, HIA Values, Advocacy, Equity, Integrated Impact
Assessment.
Contact information :
John Kemm
JK Public Health Consulting, Bromsgrove, UK
e-mail : johnkemm123@btinternet.com
John Kemm
JK Public Health Consulting, Bromsgrove, UK
1005_ 2012-10-08 5:17 16
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
17
Growing the Field of Health Impact Assessment in the
United States: A Status Report
Overview
- Timeline major events that contributed to HIA growth in the US
- Rapid growth in U.S. especially in past 5 years
- Number of HIAs completed to date
- Sectors in which HIAs have been completed
- Number of HIA papers with US authors and journals in which they are published
Examples of HIAs in US
- Trinity Plaza housing redevelopment, San Francisco
- Housing rental voucher program, Boston
- Coal-fired power plant, Florida
- Mass transit funding, California
Institutionalization
- National policies and reports supportive of HIA
National Prevention Strategy, 2011
White House Task Force on Childhood Obesity, 2010
CDC Transportation and health recommendations, 2011
National Research Council Committee on Health Impact Assessment report, 2011
- Recommendations of the National Research Council HIA report
Encourage use of HIA
Use peer review to ensure quality of HIAs
Incorporate HIA into NEPA EIA process
Use quantitative models when possible
Engage stakeholders
Build capacity to conduct HIAs
Evaluate impacts of HIA
Manage expectations of what HIA can do
HIA and Environmental Impact Assessment/National Environmental Policy Act
Integration of HIA and EIA
Alaska HIA program
Andrew L. Dannenberg, MD, MPH
Affiliate Professor, University of Washington
1005_ 2012-10-08 5:17 17
18
| Korea Institute for Health and Social Affairs, Seoul, Korea
Level of complexity of HIA: qualitative versus quantitative
Voluntary versus regulatory HIAs
- Required HIAs in US
HIA of State Route 520 bridge replacement, Seattle
HIAs required by Massachusetts Healthy Transportation Compact
- Legal review of state and local laws supportive of HIA
(http://www.healthimpactproject.org/resources/body/Legal-Review.pdf)
HIA Evaluation
- Group Health/RWJF evaluation project, 26 site visits, web survey of HIA practitioners
Preliminary observations
Capacity building
- Eight university level courses on HIA now being taught
- National HIA meetings in the US
- SOPHIA Society of Practitioners of Health Impact Assessment (www.hiasociety.org)
Future of HIA in the US
- Challenges
Funding
Quantitative vs qualitative analyses
Need for more evaluation
Anti-regulatory environment
Capacity to conduct HIAs
- Opportunities
Growing interest
Support in major national documents
Evidence of successes
Addresses social equity/health disparities
Further resources
- www.cdc.gov/healthyplaces
- www.healthimpactproject.org
Contact information :
Andrew L. Dannenberg, MD, MPH
Carter Consulting, Inc.
Consultant, Healthy Community Design Initiative
National Center for Environmental Health, Centers for Disease Control and Prevention
Affiliate Professor, University of Washington
Cell 404-272-3978; Email acd7@cdc.gov
Website: www.cdc.gov/healthyplaces
1005_ 2012-10-08 5:17 18
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
19
The RAPID guidance; a tool for policy oriented HIA
Introduction: In addition to projects and plans HIA aims to assess also potential health impacts of
policies and strategies. Due to complexity of policies this is a rather complicated task requiring time
and resources. The Risk assessment from policy to impact dimension - RAPID project funded by
European Commission aimed to develop a systematic guidance to enhance policy oriented HIA.
Methods: A consortium of 11 partners from across Europe conducted a set of case studies on risk
assessment of policies and based on them developed the RAPID guidance. The guidance has been test-
ed via conduct of risk assessment of European Commission health strategy and a series of national
workshops in participating countries.
Results: The main product of the project is the RAPID guidance in form of a checklist addressing all
levels of the full chain approach (policies determinants of health risk factors health outcome). It
is structured on four levels containing task to do and advice how to do.
Discussion: Quantification (changes in determinants, risks factors, health outcomes), differences between
determinants of health and risk factors, uncertainties and their interactions and horizontal prioriti-
zation were identified as main issues where more research is needed.
Conclusions: The RAPID guidance seems to be a promising tool well received by risk assessors and
HIA experts moreover also by representatives of other sectors. However, the guidance needs to be
tested under different context to verify its global validity.
Key words : Risk assessment, policy, health impact assessment
Contact information:
Gabriel Gulis, PhD, associate professor
Unit for health promotion research, University of Southern Denmark, Niels Bohrsvej 9-10, 6700 Esbjerg,
phone 0045 65504212, fax 004565504283, e-mial ggulis@health.sdu.dk
Gabriel Gulis
University of Southern Denmark, Esbjerg, Denmark
1005_ 2012-10-08 5:17 19
20
| Korea Institute for Health and Social Affairs, Seoul, Korea
Health, EIA, and major projects: working towards more
integrated approaches.
Project-level environmental impact assessment is well established around the world, so there are sound
reasons for integrating health considerations into those existing assessment practices, rather than
viewing HIA as a separate stand-alone process for project assessment. However, although this has
been recognised for many years (e.g. Davies and Sadler, 1997; Ahmad, 2004), progress on the whole
has been disappointing. For example, Harris et al. (2009) report a low level of health-oriented con-
tent in 25 project EIAs in New South Wales, Australia, and similar findings have been reported else-
where (e.g. Bhatia and Wernham, 2008; Morgan, 2008; 2011).
One response to this slow progress has been a renewed call for stronger HIA, with a separate iden-
tity, to ensure health is considered alongside environmental concerns (e.g. Negev et al., 2012). However,
there is the danger that by seeking to maintain a separate identity, this could in itself work to the detri-
ment of those wishing to ensure health considerations are given their due weight in project decisions.
Rather than pulling back from EIA, it would be useful to examine why EIA practitioners have been slow
to respond to the HIA communitys call for greater attention to health in project-level assessments.
In this presentation I explore some of the issues that may be impeding improvements in the treat-
ment of health within EIAs, with the intention of stimulating reflection and discussion.
I start with the question of expectations: HIA advocates have expectations of how health should be
addressed in impact assessment and consider EIA practice to be failing when it does not meet those
expectations. In very broad terms, HIA usually emphasises a wide view of health, to include social
determinants, and the notion of wellbeing. Other characteristics include a strong participatory
approach, transparency, a particular concern for health inequalities, and seeking opportunities to achieve
health benefits. Many HIAs are seen as being initiated and often conducted by, or on behalf of, pub-
lic health authorities. And it is often said that HIA brings unique methodological values that EIA lacks
(community input, equity concerns, etc.).
In contrast, EIA processes are often situated within strong institutional frameworks that tend to dic-
tate their form. Practices can easily become entrenched over the years so that observed practice in
a given jurisdiction may not represent good EIA practice principles so much as procedural expediency.
In that context, project-proponents and EIA practitioners may not welcome the pressure to carry out
an HIA in addition to an EIA. This negative view may be exacerbated by claims from HIA practition-
ers to be introducing improvements to EIA, in the shape of community and stakeholder participation
and concern for equity. Finally, the assertion that HIA is concerned with health and wellbeing, which
Richard K. Morgan
Professor, Department of Geography, University of Otago, Dunedin, New Zealand.
1005_ 2012-10-08 5:17 20
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
21
encompass all aspects of the natural, social and cultural environment (so subordinating all EIA to the
cause of health), and that the EIA process should be leveraged to identify positive outcomes for health,
will further alienate the very practitioners who will be needed if health considerations are to be given
greater prominence in EIAs.
I believe HIA needs to scale back its expectations, recognise that EIA theory and practice principles
are already highly developed (but, yes, too often poorly practised), and that it is more effective for
health impact practitioners to fit into current EIA practice and then to modify it from within, rather
than to expect EIA to adjust to the HIA view of the world.
This suggests a number of issues HIA practitioners might want to reflect on. For example:
At the project level, proponents are usually responsible for commissioning impact assessment stud-
ies, within a framework that reviews them quality and adequacy. So public health authorities/health
agencies should not conduct HIAs for projects: their role should be to advise local authorities, pro-
ponents, and impact assessment practitioners about health issues at the scoping stage, and to review
the treatment of possible health impacts within EIAs.
Health impact practitioners should focus on extending health considerations within EIA from the
current environmental health approach to address wider health determinants.
-This means working collaboratively with, for example, social and cultural impact assessors, then
extending their work to examine health consequences.
-It also means developing ways to bring all health impacts together into a coherent analysis of
total health burden, and to feed health equity issues into the wider treatment of distributional
issues in the EIA.
Health policy agendas need to be downplayed in project level impact assessment, and the focus
kept on health, not on the rather nebulous notion of wellbeing.
The health sector concept of intervention that often seems to influence HIA approaches needs
to be modified or dropped in the context of project-level HIA. It places too much attention on estab-
lishing definitive cause-effect links between project activities and possible health outcomes. EIA
does not demand the same level of certainty, because it is based on prevention as opposed to
intervention thinking.
On the other hand, EIA information used in project decisions does need to be grounded, and health
professionals need to understand how to tailor their information to the needs of the decision-mak-
ing process.
In return, HIA practitioners can reinvigorate EIA processes that in many countries have become
mechanical, have drifted away from basic impact assessment principles, or lost touch with the latest
thinking about new methods and techniques. And through the use of health, they can help bind the
various threads of the impact assessment together, and make the link back to local communities.
1005_ 2012-10-08 5:17 21
22
| Korea Institute for Health and Social Affairs, Seoul, Korea
Overall, I feel a more considered approach to building health considerations into project-level EIA will
rebuild trust and respect for HIA among the wider impact assessment community and provide the basis
for a truly integrated approach.
References.
Ahmad, B.S. (2004) Integrating health into impact assessment: challenges and opportunities. Impact
Assessment and Project Appraisal, 22: 2-4
Bhatia R., and Wernham, A. (2008) Integrating human health into environmental impact assessment:
an unrealised opportunity for environmental health and justice. Environmental Health
Perspectives, 116: 991-1000
Davies, K., and Sadler, B. (1997). Environmental Assessment and Human Health: Perspectives,
Approaches, and Future Directions. Ottawa: Health Canada.
Harris, P.J., Harris, E., Thompson, S., Harris-Roxas, B. and Kemp, L. (2009) Human health and well-
being in environmental impact assessment in New South Wales, Australia: Auditing health impacts
within environmental assessments of major projects. Environmental Impact Assessment
Review, 29: 310318
Hilding-Rydevik, T., Vohra, S., Ruotsalainen, A., Pettersson, A., Pearce, N., Breeze, C., Hrncarova, M.,
Liekovska, Z., Paluchova, K., Thomas, L. and Kemm, J. (2006) Health Aspects in EIA. D 2.2
Report WP 2. Improving the Implementation of Environmental Impact Assessment (IMP)3, Sixth
Framework Programme, European Commission.
Morgan RK. (2008) Institutionalising health impact assessment: the New Zealand experience. Impact
Assessment and Project Appraisal, 26: 2-16.
Morgan, R.K. (2011) Health and impact assessment: Are we seeing closer integration? Environmental
Impact Assessment Review, 31: 404411
Negev, M., Levine, H., Davidovitch, N., Bhatia, R. and Mindell, J. (2012) Integration of health and envi-
ronment through health impact assessment: Cases from three continents. Environmental
Research, 114: 60-67
Contact information:
Professor Richard K. Morgan
http://www.geography.otago.ac.nz rkm@geography.otago.ac.nz
Centre for Impact Assessment Research and Training (CIART) Department of Geography/ Te Ihowhenua
University of Otago / Te Whare Wananga o Otago P.O. Box 56
Dunedin
New Zealand/Aotearoa
work phone: (+64)-3-479-8782
1005_ 2012-10-08 5:17 22
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
23
Health Impact Assessment: Triumph over common
sense?
Evaluations of health impact assessments (HIAs) have highlighted its potential impacts on decision-
making, implementation and broader factors such as intersectoral collaboration (Harris-Roxas et al.
2011, Harris-Roxas et al. 2012b, Wismar et al. 2007). Tensions often arise between stakeholders
about the outcomes of HIAs however. Studies that have looked at this have found that there are:
Often disagreements between stakeholders about the perceived purpose of the HIA and what
form it should take (Harris-Roxas et al. 2012a, Harris-Roxas & Harris 2011); and
The perception that an HIAs recommendations could have been identified through normal
planning and implementation processes and that the HIA didnt necessarily have to be conducted
(Harris-Roxas et al. 2011). In other words, that an HIAs recommendations are common
sense.
These two issues, about the perceived purpose of HIA and the common sense nature of HIAs rec-
ommendations, lie at the heart of any discussion of the HIA effectiveness. These issues have also been
under-explored in the literature to date.
This plenary will present initial findings from a study that looked at two decision-support equity-focused
HIAs of similar health sector proposals (local health service obesity prevention and treatment ser-
vice plans) longitudinally. This involved conducting 23 semi-structured interviews with key stakeholders
before, during and after the HIAs, and document reviews. One of the HIAs was completed while the
other one was screened and determined to be unnecessary. This study is unique in relation to HIA to
the authors knowledge, because it looks at expectations and perceptions of effectiveness before and
after the HIAs were completed. It also compares two similar planning situations, one in which an HIA
was conducted and one in which the HIA was screened out.
The studys findings highlight that while many of the recommendations and distal impacts of an HIA
(Harris-Roxas & Harris 2012) could notionally be anticipated through common sense analysis, in prac-
tice they are rarely foreseen. A similar phenomenon has been demonstrated in other fields such as
organisational psychology and management (Orrell 2007, Watts 2011). This study also highlights the
critical role that learning plays in impact assessment practice (Morgan 2012, Bond & Pope 2012). This
learning takes three forms: technical, conceptual and participatory (Harris & Harris-Roxas 2010,
Glasbergen 1999). Learning may also take place at individual, organisational and social levels.
This suggests that common sense is anything but common in the real world of planning and decision-
making. What seems obvious in hindsight is rarely apparent in advance. HIA, as a structured process
for looking at under-considered impacts, has an important role to play in moving beyond common
sense towards broader learning and more nuanced analyses of alternatives.
Ben Harris-Roxas
Conjoint Lecturer, Centre for Primary Health Care and Equity, University of New South Wales, Australia; Consultant, Harris-Roxas Health;
Health Section Co-Chair, International Association for Impact Assessment
1005_ 2012-10-08 5:17 23
24
| Korea Institute for Health and Social Affairs, Seoul, Korea
References.
Bond A, Pope J (2012) The State of the Art of Impact Assessment in 2012, Impact Assessment and
Project Appraisal, 30(1):1-4. doi:10.1080/14615517.2012.669140
Glasbergen P (1999) Learning to Manage the Environment in Democracy and the Environment: Problems
and Prospects (Eds Lafferty W and Meadowcroft J), Edward Elgar: Cheltenham, p 175-193.
Harris-Roxas B, Harris E (2011) Differing Forms, Differing Purposes: A Typology of Health Impact
Assessment, Environmental Impact Assessment Review, 31(4):396-403.
doi:10.1016/j.eiar.2010.03.003
Harris-Roxas B, Harris E (2012) The Impact and Effectiveness of Health Impact Assessment: A con-
ceptual framework, Environmental Impact Assessment Review:accepted, in press
Harris-Roxas B, Harris P, Harris E, Kemp L (2011) A Rapid Equity Focused Health Impact Assessment
of a Policy Implementation Plan: An Australian case study and impact evaluation, International
Journal for Equity in Health, 10(6), doi:10.1186/1475-9276-10-6.
http://www.equityhealthj.com/content/10/1/6
Harris-Roxas B, Harris P, Wise M, Haigh F, Ng Chok H, Harris E (2012a) Health Impact Assessment
in Australia: Where weve been and where were going in Past Achievement, Current Understanding
and Future Progress in Health Impact Assessment (Ed Kemm J), Oxford University Press:
Oxford, p accepted - in press.
Harris-Roxas B, Viliani F, Bond A, Cave B, Divall M, Furu P, et al. (2012b) Health Impact Assessment:
The state of the art, Impact Assessment and Project Appraisal, 30(1):43-52.
doi:10.1080/14615517.2012.666035
Harris E, Harris-Roxas B (2010) Health in All Policies: A pathway for thinking about our broader soci-
etal goals, Public Health Bulletin South Australia, 7(2):43-46.
http://www.dh.sa.gov.au/pehs/publications/public-health-bulletin.htm
Morgan RK (2012) Environmental impact assessment: the state of the art, Impact Assessment and
Project Appraisal, 30(1):5-14. doi:10.1080/14615517.2012.661557
Orrell D (2007) The Future of Everything: The science of prediction. Basic Books: New York.
Watts D (2011) Everything Is Obvious (Once you know the answer). Crown Publishing: New York.
Wismar M, Blau J, Ernst K, Figueras J (Eds.) (2007) The Effectiveness of Health Impact Assessment:
Scope and limitations of supporting decision-making in Europe, European Observatory on Health
Systems and Policies, World Health Organization: Copenhagen. International Standard Book
Number 978 92 890 7295 3.
Contact information:
Ben Harris-Roxas
Harris-Roxas Health
4/26 Elizabeth St
Granville NSW 2142 Australia
Phone : +61 413679 962
E-mail: ben@harrisroxashealth.com
1005_ 2012-10-08 5:17 24
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
25
BACTERIAL AND FUNGAL PROFILE AND ANTIMICROBIAL
SUSCEPTIBILITY PATTERN FROM PATIENTS OF CHRONIC
SUPPURATIVE OTITIS MEDIA WITH SPECIAL EMPHASIS ON SEASONAL
VARIATION AT CIVIL HOSPITAL KARACHI PAKISTAN.
INTRODUCTION: Chronic Suppurative Otitis Media (CSOM) is defined as chronic otorrhea for 6-12
weeks through a perforated tympanic membrane. The most common organism isolated nowadays are
Pseudomonas aeruginosa, Staphylococcus aureus, Proteus spp, Klebsiella spp among aerobes while
the most common fungi are Aspergillus and Candida species. CSOM can cause significant morbidi-
ty. The first line of CSOM management is topical antibiotic initiated empirically on the basis of known
bacteriological profile. Following advent and usage of newer synthetic antibiotics there has been a change
in resistance patterns of the microbes, therefore knowledge of microbial profile and antibiotic sus-
ceptibility pattern is essential to enable efficacious treatment of this disorder.
MATERIALS AND METHODS: The study was conducted from January 2011 to December 2011 at
the department of ENT and Central Lab, Civil Hospital Karachi. A total of 251 patients with unilater-
al or bilateral chronic suppurative otitis media attending the outpatient clinic or admitted in the ENT
Wards were included in this study. Pus samples (Ear swabs) were collected from the discharging ear(s)
and sent to Central Lab, Civil Hospital Karachi for Culture and sensitivity test where Aerobic cultures
were done and Antibiotic sensitivity testing was done by Kirby-Bauer disk diffusion technique.
RESULTS: From the clinical specimens of 251 patients, the pathogens were isolated in 206 (82.07)
patients out of which 201 (98) were bacterial isolates and 5 (2) were fungi. Pseudomonas aerug-
inosa was the most common bacteria isolated in 141 (68.44), followed by Staphylococcus aureus
in 53 (25.72) cases. Antibiotic sensitivities of Pseudomonas aeruginosa showed that 100 isolates
were sensitive to Carbapenums, where as 97 isolates were sensitive to sparfloxacin and 95 to
Sulbactam/cefoperazone, piperacillin/tazobactam, 68 were sensitive to aztreonam, 65 to chlo-
ramphenicol. For Staphylococcus aureus, 94.3 isolates were sensitive to Fusidic acid, 92 to Linezolid
and 90 to vancomycin, 66 to amoxicillin and 60 to ciprofloxacin, ofloxacin.
CONCLUSION: Pseudomonas aeruginosa was the most common isolate followed by Staphylococcus
aureus. Clustering of cases was seen during the summer season. More than 80 of Pseudomonas
aeruginosa were sensitive to carbapenems and bte-lactamase inhibitors while fusidic acid, vancomycin
and linezolid were found to be most sensitive for strains of Staphylococcus aureus. It is therefore con-
cluded that the topical preparation of these antibiotics should be incorporated in the course of ther-
apy to cover up the most frequent aerobic isolates implicated in CSOM.
Key words: CSOM, Microbiological Profile, Culture and Sensitivity
Contact Information:
Dr Ghulam Fatima
Senior Pathologist and Incharge Department of Microbiology
Central Lab.
Civil Hospital, Karachi, Pakistan.
Email. drfatima63@gmail.com
Ph. Off. ++92-21-99215740 EXT. 5005
Cell 03002605992
M.ZEESHAN RAZA
1
, SYED BILAL
1
, MARIA SHOAIB
1
, GHULAM FATIMA
2
1: Medical Student, Dow University of Health Sciences, Karachi, Pakistan.
2: In-charge, Department of Microbiology, Central Lab, Civil Hospital Karachi, Pakistan.
1005_ 2012-10-08 5:17 25
26
| Korea Institute for Health and Social Affairs, Seoul, Korea
Estimating the effect of health state on
intergenerational poverty in Senegal
Hounkpodote Hilaire Guy Adetona
Laboratory for Research on Social Transformations, Dakar, Republic of Senegal
Introduction: The strong correlation between poverty and health problems is known. However the
dynamics of the phenomenon leads to the need for further studies and research to understand the
situation. In this paper, we estimate the effect of health state on intergenerational poverty in Senegal.
Data from vulnerabilities and chronic poverty survey in Senegal which is a biographical type survey
conducted by the Laboratory for Research on Social Transformations over the 2008/2009 period
are used. The sample for this survey consists of 1,200 households and 2,400 biographies. This paper
aims to introduce the longitudinal approach in the analysis of health and poverty in Senegal.
Methods: When treatment assignment is unconfounded with outcomes conditional on a possibly large
set of covariates, Hirano and Imbens (2001) have proposed a class of estimators of effect based on
weighted estimation of the regression function. We use a propensity score weighted regression to esti-
mate the health state effect. It is a combination of propensity score matching and weighted OLS regres-
sions. The treatment group is the group that the duration of disease is greater than or equal to six
months and the control group is the group that duration of disease is less than six months.
Results: The results indicate that the effects are significant for all generations. The duration in the
disease has an effect on well-being approached by the poverty state. In fact, the effect (0.20) is sig-
nificant at the 5%level for the older generation (before 1954) and the effect (0.38) is significant at
1%level for the younger generation (after 1978), while the effect (0.12 for 1954-1968 generation
and 0.14 for the 1969-1978 generation) is significant at the 10%level for the others generations
(1954-1968 and 1969-1978).
Discussion and Conclusions: This analysis allows us to conclude that the older and younger gen-
erations are much more vulnerable to poverty when the duration of disease is high. The disease has
led to the cessation of activities of individuals. Thus in 28.7%of cases, the disease has led to the ces-
sation of professional activity with a suspension of their salaries. Investments in health and raising
the standard of education must engage one of the largest shares of national and local budgets. The
social protection programs should be established as a national priority in order to promote the inclu-
sion of vulnerable groups and rehabilitation in development.
Keywords: Health, intergenerational poverty, propensity score weighted
Contact Information:
Mr. Hounkpodote Hilaire Guy Adetona
Laboratory for Research on Social Transformations (LARTES IFAN)
Address: University Cheikh Anta Diop of Dakar (UCAD), BP: 206 Dakar, Senegal
Zip code: 00221
Country: Senegal
Phone: +221 77 385 73 00
E-mail: hilarguo@yahoo.fr
1005_ 2012-10-08 5:18 26
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
27
Training and capacity building of different implementa-
tion models in three Danish local municipalities
Peter Gry
1
, Mette Winge Fredsgaard
1
1: University of Southern Denmark, Esbjerg, Denmark
Introduction: The Healthy Cities Network in Denmark has developed a pilot project on increasing capac-
ity building of utilising health impact assessment (HIA) in local and regional organisations. The pur-
pose of this project is to develop training material, courses, implementation models, and electronic
platform for exchange of experience and further to test the implementation models in selected
municipalities. The focus of this abstract is on the capacity building, training and implementation mod-
els.
Methods: This qualitative research consisted of focus group interviews carried out in three munici-
palities, who are testing the different implementation models. Interviewees included employees from
the public health, urban, environment and technical departments. Major questions for the focus group
interviews included contextual factors such as administrative support, interdisciplinary collaboration
and competences within the domain of health determinants. Other main questions included chang-
ing mechanism factors such as awareness of health promotion, attitudes towards utility of HIA and
motivation on using HIA.
Results: All interviewees in the municipalities, who participated in training courses, reported a high-
er awareness of HIA and its utility after participating in the training courses. Furthermore, all non-
health interviewees stated a better understanding of (the determinants of) health and an improved
interdisciplinary collaboration, especially with the public health department, as a main outcome. The
three different implementation models had a mixed response in the municipalities. One municipali-
ty reported their model as useful because of increased knowledge of other staffs competences than
their own and a further development of an integrated health/environment screening. Another
municipality described their model as less effective due to undelivered expectation of a training
course and absence of key personal in the implementation process. The last municipality had used
the implementation model as a launch pad for developing a sustainable strategy and tool in accor-
dance with Local Agenda 21 and Aalborg Commitments.
Discussion and Conclusions: The pilot project identified several facilitators and barriers in the imple-
mentation models for increasing the utilisation of HIA. Among these were specific course workshops
and both administrative and political support to the project.
Key words: implementation, capacity building, utilization
Contact Information:
Mr. Peter Gry
University of Southern Denmark, Unit for Health Promotion Research
Niels Bohrs Vej 9
6700 Esbjerg, Denmark
Phone : +45 6550 4245
Fax: : +45 6550 4283
E-mail: pgry@health.sdu.dk
1005_ 2012-10-08 5:18 27
28
| Korea Institute for Health and Social Affairs, Seoul, Korea
Impact of electrification on human health evidence
from rural Bhutan
Rauniyar, Ganesh P.
1
1: Independent Evaluation Department, Asian Development Bank, Manila, Philippines
Abstract
Introduction: The paper examines health impact of the Asian Development Banks assistance for rural
electrification in Bhutan, comprising two loans approved in 1999 ($9.8 million) and 2003 ($12.8 mil-
lion). Rural electrification has been attributed to improved indoor air quality and better health out-
comes, including reduced incidence of acute respiratory infections. In Bhutan, households still depend
heavily on fuelwood for cooking but have started partially switching to the use of electrical appliances.
Methods: In the absence of baseline data, the study adopted propensity score matching method.
Propensity scores were estimated for electrified households by a logit regression model that poten-
tially affected the outcomes of interest. Household level fixed characteristics, such as age, gender, mar-
ital status, religion, education of household head, land ownership, household size, ownership of live-
stock type of house, and main source of drinking water were used as the control variables. In addi-
tion, a few village level variables such as distance to district headquarters, area and population of the
village, and availability of educational infrastructure were also used to estimate the propensity scores.
The household survey covered 2098 households representing all agro-ecological zones.
Results and Discussion: The study shows that electrification improves health conditions and reduces
the occurrence of health incidences associated with fuelwood and other polluting energy sources such
as candles and kerosene lamps. Members in electrified houses encountered a lower incidence of adverse
health (cough, eye irritation and headache) compared to those in un-electrified households. However,
no statistical difference was noted with respect to respiratory ailments. The results are consistent with
similar studies in other countries at similar level of socioeconomic development. While electricity access
has provided better lighting of indoors, use of electrical appliances for cooking is limited in rural Bhutan
to rice cookers and water boilers. This may be a plausible explanation of no significant impact on res-
piratory ailments.
Conclusion: Rural electrification can be attributed to reduced incidence of selected health ailments
associated with improved indoor air quality. Efforts are needed to substantially reduce the use of fuel-
wood for cooking in rural households with energy efficient electrical appliances.
Key words : impact evaluation, electrification impact on health, indoor air quality
Contact Information:
Dr Ganesh P. Rauniyar
Principal Evaluation Specialist
Asian Development Bank
Independent Evaluation Department
Mandaluyong City, Metro Manila 1550
Philippines
Tel: +63-2- 632-4593/5039
Fax: +63 -2 636-2163
Email: grauniyar@adb.org
1005_ 2012-10-08 5:18 28
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
29
Embed Health Impact Assessment into Free Trade
Negotiation Processes
Kessomboon Nusaraporn
1
1: Faculty of Pharmaceutical Sciences, Khon Kaen University, Thailand
Introduction: There are concerns for the impacts of free trade agreements on people well-being. Many
sectors in Thailand then have been calling to have careful consideration on all possible impacts on health
and well-being through the whole processes of developing any free trade agreements (FTA). The pur-
pose of this study was to review documents related to free trade negotiation and health impact assess-
ment (HIA) in Thailand.
Methods: This documentation research incorporated primary, secondary and tertiary documents. The
primary sources refer to materials which are written or collected by those who actually witnessed events.
The secondary sources are written materials after an event that the author has not personally wit-
nessed. Tertiary sources enable researchers to locate other references such as indexes, abstracts and
other bibliographies including internet search engines.
Results: HIA in Thailand becoming strongly entrenched within law and policy drawing from the consti-
tutional requirement. This constitutional provision motivated the 2007 endorsement of a National Health
Act to establish HIA into national policy, program, project, and also creating a National Health Commission
to prescribe rules and procedure on HIA. In 2010, the Commission issued rules and procedures for HIA
in public policies It recommended to conduct HIA for a range of policies, including free trade agree-
ments. In addition, the 3rd National Health Assembly in December 2010 recognized the limitations of
mechanisms and processes relating to free trade negotiation on the goods that have impacts on well-
being and society and on relevant services; the limitations of integrated operations, participation, con-
crete implementation, the application of academic knowledge, and the process to enforce the resolu-
tions of the National Health Assembly concerning free trade. Therefore, the assembly resolves the res-
olution on The prevention of the impacts of free trade on well-being and society. At present, the
Secretary-General to the National Health Commission is preparing to organize an issue based health
assembly to consider criteria and methods for HIA in the free trade negotiation processes.
Discussion and Conclusions: This study showed the success of advocacy to ensure that FTA should
not be conducted without HIA. In addition, the key to get success in embedding HIA into the free trade
negotiation processes in order to promote the well being of people is the synergy between three sides
of the triangle; a.) knowledge and evidence generation, b.) mobilization of civil society and public sup-
port, and c.) the leadership of politicians and policy makers.
Key words : HIA, Freetrade, Negotiation
Contact Information:
Assoc Prof Dr Kessomboon Nusaraporn
Faculty of Pharmaceutical Sciences,
Khon Kaen University,
Khon Kaen 40002
Thailand
Phone : +66-4-336-2090
Fax: : +66-4-336-2090
E-mail: nustat@kku.ac.th
1005_ 2012-10-08 5:18 29
30
| Korea Institute for Health and Social Affairs, Seoul, Korea
HIA in ASEAN Community
Suwanakitti Tanita
1
, Pengkam Somporn
1
, Kessomboon Nusaraporn
2
1: National Health Commission Office, Bangkok, Thailand
2: Khon Kean University, Khon Kean, Thailand
Introduction: As for the ASEAN will become One vision One identity One community on 2015, trans-
boarder impact must be seriously consider avoiding the impact to peoples well-being. The objec-
tive of this study was to review the HIA development in ASEAN Community.
Methods: Data collection based on the secondary data including formal meeting minutes and reports.
Results: The results showed that HIA has been implemented in all ASEAN member states in the
form of EHIA. HIA case studies in Lao PDR and Thailand, apart from being a good learning
process, have proven to be very useful in providing supportive information for EIA reports.
Singapore uses HIA for case study. In addition, Vietnam also regulate that HIA must be done for
projects on building industrial zones, cities, health care facilities for infectious patients. Thailands
approach uses a public policy process to advocate HIA at the policy level, and at the community
level.
Discussion and Conclusions: Therefore, institutionalization of HIA in ASEAN may be considered
by aligning it within the existing ASEAN and other regional platforms.
Key words : HIA, ASEAN, Institution
Contact Information:
Ms.Suwanakitti Tanita
National Health Commission Office
Fl.3 National Health Building
88/39 Moo.4 Tiwanon 14 Rd., Talad Khwan, Mueang District
Nonthaburi 11000
Thailand
Phone: +66-2-832-9084
Fax: +66-2-832-9002
E-mail: thanita@nationalhealth.or.th
1005_ 2012-10-08 5:18 30
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
31
The Need and Readiness for Health Impact
Assessment of the Organizations in Thailand.
Phen Sukmag
1
, Pongthep Suteeravut
2
, Syuwari Morzu
2
1: Faculty of Environmental Management, Prince of Songkla University, Songkla, Thailand.
2: Health System Management Institute, Prince of Songkla University, Songkhla, Thailand.
Introduction: The National Health Commission Office of Thailand has regulated the procedures of health
impact assessment (HIA) for healthy public policy in four cases. Firstly, HIA under the Constitution of
Thailand the year 2007, Section 67 (2); E-HIA. Secondly, HIA which request by people in accordance
with their right as accorded by section 11 of the National Health Act 2007. Thirdly, HIA in the case
of the development of a public policy and development planning activity. Finally, HIA for learning in
the community; community health impact assessment; CHIA. Therefore, HIA in Thailand has linked
in four main organizations; the government organization, civil society organization, private sector orga-
nization and local authority. The objective of this study was in order to examine the need and avail-
ability for health impact assessment of the organization in Thailand, in order to develop the building
capacity and HIA training in the organization.
Methods: The objective of this study were to explore the need assessment and readiness of HIA in
four groups; the government organization, private sector organization, local authority and civil soci-
ety organization. The representative of each group was selected by the purposive sample sampling
method. The study data were collected using participatory observation. One-to-one interviews
were conducted with 63 key informants, all of which were finally analyzed using group discussion and
thematic content analysis method.
Results: The results revealed that, the barriers for HIA implementation in Thailand as follow. In the
national level, the legal instruments amended regularly, all the organizations not set HIA policy. Existing
legislation does not support full assessment, including screening and public scoping, public review.
The interviewees feedback that most of the organization lack of importance resource; human, tools,
financial, HIA knowledge, HIA experience. More than a haft of organization can not support resource
for HIA.
Discussion and Conclusions: In Thailand, the HIA procedure regulated scoping as public scoping and
review as public review. It is extremely difficult for the assessor and the relevant organization to con-
duct HIA because lack of public scoping tools and pubic review tools. The results of this study we taken
for HIA training in Thailand.
Keywords: HIA Need assessment, HIA traning and building capacity
Contact Information:
Miss Phen Sukmag
Faculty of Environmental Management,
Prince of Songkla University, Hatyai Campus, Hatyai, Songkla, 90112, Thailand.
Phone : +66-8-959-51811
E-mail: sphen013@yahoo.com
1005_ 2012-10-08 5:18 31
32
| Korea Institute for Health and Social Affairs, Seoul, Korea
Community Based Project Management: a Promising
Approach for Alleviating Sub Standard Neighborhood
in Indonesia
Asnawi Manaf
1
1: Urban and Regional Planning Department, Diponegoro University, Semarang, Indonesia
Introduction: In recent decade, the Indonesia's housing policies are marked by the continuous
decrease of the states role in ensuring the fulfilment of the people housing needs. These quasi "lais-
sez faire-policies" lead, however, to unfair distribution of social goods in the society including in the
housing sector. To respond the weakness of this policy, the Indonesian state ministry for people hous-
ing gives more attention on the so called community based approaches. Recently, the government
introduces a program called community based sub standard neighborhood improvement (in bahasa:
Program Peningkatan Kualitas Perumahan).
Methods: This article aims at describing a case study research result on the implementation of the
PKP Program in Pringapus Village, Semarang District, Indonesia. The research was conducted from
2009-2010. The qualitative research method (participatory action research) had been employed,
where the researcher was also partly involved in the implementation process as an observer.
Results: In case of the PKP Project implemented in the Pringapus Village it shows that there is
measurable success story in dealing with the housing problem for the poor. However, to make it more
sustainable, it is necessary to integrate PKP project which is only clustered in the neighborhood level
with the development plan in the city-wide level. Besides, good social capital in the area is the pre-
requisite of the success of the program. The role of local voluntary organization (BKM) is also one of
determining factors for the success. In practice, BKM can organize and mobilize the social resources
and local know-how to support the implementation of the project.
Discussion and Conclusions: This paper concluded that community based project management
approach can increase transparency and accountability in determining the real target group (ben-
eficiaries) and mobilizing of the social resources available in the community to support the project so
that the project can be accomplished with high added value of output.
Keywords: community based project management, local voluntary organization, and sub standard neigh-
borhood improvement program.
Contact Information:
Dr. Ing. Asnawi Manaf
Urban and Regional Planning Department, Diponegoro University,
Jl. Prof. Sudharto, SH. Tembalang, Semarang, 50271, Indonesia
Phone : +62 24 7460054
Fax: : +62 24 7460054
E-mail: asnawimanaf@undip.ac.id or asn2407@yahoo.com
1005_ 2012-10-08 5:18 32
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
33
Health Impact Assessment, a process of harnessing
wisdom or squeezing in data?
Domyung Paek, Seoul National University
HIA is to provide recommendations for public policy based on scientific discipline. Hopefully, it should
be an approach to apply a wisdom garnered through scientific work to areas that need another wis-
dom. However, in reality, it tends to be an approach to squeeze a few data collected in haphazard way
to unexplored possibilities. This is especially true in countries with very few its own database.
Here in this presentation, I will explain about the differences between data, information, knowledge,
and wisdom, and the way to get wisdom starting from data. In this fashion, wisdom cannot be derived
directly from data itself.
I will also present the global situation of asbestos ban. Even though asbestos hazard is so widely known,
less than 50% of those countries that have used asbestos have banned its further use. As for
asbestos, the most intensely studied hazardous material, health impact assessment should have yield-
ed the same recommendation, but in fact it havent. I will explore why.
In the last summary, I will try come up with a few essential elements of HIA to have any meaning in
those countries with so little experiences.
Keywords: Data and Wisdom, Asbestos Ban, Validation, Evaluation, Participation
Contact Information:
Domyung Paek, MD, MSc, ScD
Professor, Occupational and Environmental Medicine
School of Public Health, Seoul National University
1 Gwanak-ro, Gwanak-gu, Seoul 151-742, Korea
(T): +82+2+880-2733 (F): +82+2+743-8240
paekdm@snu.ac.kr http://www.health21.or.kr
1005_ 2012-10-08 5:18 33
34
| Korea Institute for Health and Social Affairs, Seoul, Korea
Application of Exposure Science and Risk Assessment
in HIA
Kiyoung Lee
1
1: Seoul National University, Seoul, Korea
Introduction: Health impact assessment (HIA) can be defined in many different manners. Generally
speaking, HIA can be described as approach to help identify and consider the potential health impacts
of a proposal on a given population. The primary purpose is to provide evidence-based recommen-
dations for the decision-making process. The recommendation of HIA can highlight practical ways
to enhance positive impacts and remove or minimize negative impacts on health that might arise.
Exposure and Risk Assessment: Exposure science can apply direct measurement and indirect esti-
mation to determine exposure. Direct measurement can often provide better estimation of popula-
tion exposure, although it requires more resources and time. However, direct measurement is not applic-
able in HIA, because HIA is to consider potential health impact of a non-existing circumstances. Exposure
and risk assessment in HIA may be limited to indirect estimation.
Application of Exposure and Risk Assessment in HIA: Results of indirect estimation of exposure and
risk can be affected by level of input data. For a proposal, input information can be simple estimation
with high uncertainty. Unlike existing exposure, the most HIA process should be based on best avail-
able evidence and estimation. Indirect exposure assessment in HIA can be classified into quantita-
tive and qualitative approaches. In exposure science and risk assessment, quantitative approach is
always preferred to qualitative approach. However, selection of quantitative and qualitative estima-
tion is up to the purpose of HIA. It should be noted that HIA is to inform decision-maker the best avail-
able evidence.
Discussion and Conclusions: HIA in Korea is still under development. However, its need is obvious for
protecting population from potential health impacts of a proposal. It is clear that HIA should be on-
going process to develop further whenever new and clear evidence is emerged.
Keyworkds : Qualitative, Quantitative, Model. Exposure estimation
Contact Information:
Dr. Kiyoung Lee
Seoul National University
Graduate School of Public Health
1 Gwanak-ro Gwanak-gu, Seoul, 151-742 Korea
Phone : +82-2-880-2735
Fax: : +82-2-762-2888
E-mail: cleanair@snu.ac.kr
1005_ 2012-10-08 5:18 34
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
35
Is HIA Effective for Top Level Administrative Plan?
Young Soo Lee
1
1: Korea Environment Institute, Seoul, Korea
Introduction: HIA in EIA started in 2010 in Korea and target project of HIA was restricted to several
big projects like industrial complex construction, power plant construction. From 2010, many HIA have
been carried out in EIA process and HIA in EIA was considered to be valid. On the other hand, we would
like to confirm feasibility of HIA for top level administrative plan in order to enlarge target of HIA. So
we accomplished HIA on industrial complex supply plan, the top level administrative plan for indus-
trial complex development.
Methods: We analyzed the contents of 2nd industrial complex supply plan (2002~2011) and executed
screening, scoping, appraisal, making recommendation and monitoring plan.
Results: Because of lack of information in detail, it is very difficult to analyze impact on health quan-
titatively. So, qualitative recommendation was given.
Discussion and Conclusions: The recommendation for industrial complex supply plan is that prepa-
ration of a few executive plans is necessary when lower level plan for industrial complex development
is set up. 1st, there is a need to prepare a plan for enhancement of workers health. 2nd, adoption of
concept of eco industrial park in industrial complex supply plan is needed to consider environmental
pollution, health of people living near industrial complex. 3rd, sustainable plan is needed to consid-
er environment, nature, civilian, job and cooperation with local community. The problem is that this
recommendation is ambiguous and that kind of recommendation can be made without HIA.
Key words : HIA, Industrial complex supply plan,
Contact Information:
Dr. Young Soo Lee
Korea Environment Institute
Jinhungro 290, Bulgwang-dong, Eunpyeong-gu, Seoul, 122-706, Korea
Phone : +82-2-380-7657
Fax: : +82-2-380-7744
E-mail: leeys@kei.re.kr
1005_ 2012-10-08 5:18 35
36
| Korea Institute for Health and Social Affairs, Seoul, Korea
HIA on Dam Construction in Korea
Young Soo Lee
1
1: Korea Environment Institute, Seoul, Korea
Introduction: HIA in EIA started in 2010 in Korea, although, dam construction is not the target pro-
ject of HIA. Dam gives lots of adverse impact on health as well as environment. For example, fog formed
by increase of water body reduces sun light and agricultural product. And if there are mines at the
upstream of dam, the pollutants like heavy metals concentrated in dam and, therefore, water pollu-
tion is expected. So, there is need of HIA implementation on dam construction. We had HIA on
multi-purpose dam of which several mines exist at the upstream to confirm the effect of heavy metal
on health of people using the water inside the dam.
Methods: We calculated the concentration of heavy metals in water body with mathematical equa-
tion and compared it with national standards for protection of human health in order to confirm the
impact on health. Besides that, we examined the change of fog formation day and the impact caused
by fog formation.
Results: There is no adverse impact from heavy metals leached out by water mines. The number of
fog formation day increased by 8 days and illumination time decreased by 32 hours within water reser-
voir areas.
Discussion and Conclusions: Because there is no strong evidence for fog-health relation, it is not sure
the dam gives bad impact on human health. Furthermore, because there is no effective measures to
reduce harmful effect after dam construction, sincere monitoring for weather change, agricultural prod-
uct amount, and health of residents is recommended.
Key words : HIA, Dam construction, Mineral mines, number of fog formation day
Contact Information:
Dr. Young Soo Lee
Korea Environment Institute
Jinhungro 290, Bulgwang-dong, Eunpyeong-gu, Seoul, 122-706, Korea
Phone : +82-2-380-7657
Fax: : +82-2-380-7744
E-mail: leeys@kei.re.kr
1005_ 2012-10-08 5:18 36
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
37
Health Impact Assessment in Healthy Cities in Korea
Dongjin Kim
1
1: Korea Institute for Health and Social Affairs, Seoul, Korea
Introduction: WHO identified healthy public policy as one of the five key elements in promoting health
in the Ottawa Charter. A healthy public policy refers to a policy that seeks to promote health of indi-
viduals or local communities affected by the policy and to improve equity in health. Health impact assess-
ment can become the most appropriate means of implementing healthy public policies.
Methods: Health impact assessment targeting healthy cities projects was undertaken to build health
public policies at local government level from 2009 in Korea. The health impact assessment projects
began by inviting the local governments of the Healthy Cities Partnership that wished to participate
in the projects. The projects were immediately carried out using detailed tasks and timelines deter-
mined in discussions with project officers of each local government.
Results: A total of 14 health impact assessment projects were conducted for 3 years between 2009
and 2011, on a wide range of areas including residential environment, sport facilities and park cre-
ation, transportation, and air pollution. Health impact assessment in healthy cities defines health broad-
ly and comprehensively to include physical, mental and social well-being, and takes into account var-
ious types of determinants of health, including social and physical environments of local communi-
ties. Also, health impact assessment brings health and equity into the center of all policy, project or
program considerations for all sectors including health.
Discussion and Conclusions: Following benefits can be expected by introducing health impact assess-
ment in the course of implementing a healthy city: First, health impact assessment provides a more
comprehensive set of information that can be used as the basis for decision-making and priority-set-
ting. Second, once decisions are made, health impact assessment enables decision-makers to bet-
ter respond to health problems. Third, decision-makers are made aware of health as an important
aspect of sustainable development. Fourth, health impact assessment helps bring attention to the health
and well-being of local residents. Fifth, health impact assessment provides an opportunity to learn
and advance the process of improving health in a wide range of sectors, not just in the health or health
determinants sector. Sixth, health impact assessment makes it possible to utilize resources before prob-
lems occur, not after problems occur.
Keywords : Health Impact Assessment, Healthy City, Determinant of Health, Healthy Environment
Contact Information:
Dongjin Kim
Associate Research Fellow
Korea Institute for Health and Social Affairs
Jinhungro 268, Bulgwang-dong, Eunpyeong-gu, Seoul, 122-705 Korea
Phone : +82-2-380-8278
Fax: : +82-2-353-0344
E-mail: djkim@kihasa.re.kr
1005_ 2012-10-08 5:18 37
38
| Korea Institute for Health and Social Affairs, Seoul, Korea
Using community knowledge in promoting health:
Examples from two case studies in Seoul
Jinhee Kim, Seunghyun Yoo
Graduate School of Public Health, Seoul National University, Seoul, Korea
Introduction: Traditionally, policies and programs to promote community health are developed from
evidence produced by outside experts. This approach may lead to insufficient responses to the com-
munitys actual concerns. By reviewing cases of two studies recently conducted in Seoul, this paper
emphasizes the role of community knowledge as valid evidence for health promotion.
Methods: In the first case, 12 citizens were asked to unveil the meaning of walking in the city and its
facilitating factors and barriers through a participatory process called photovoice. In the second case,
17 teenage students were interviewed in focus groups to explore factors associated with bicycling to
school.
Results: In the first case, walking was regarded not only as a physical activity, but a very important
activity for mental and psychosocial health for urban residents. Social environments conducive for
walking, such as assimilation with the surroundings, feeling of ease and relaxation, friends and fam-
ily to accompany, were considered to be as important as the physical environments such as access
to walking-friendly street design. Barriers include factors related with street infrastructure such as
lack of walkable streets and poor street design, with emphasis on obstructive behavior incurred by
poor sense of citizenship. The second case revealed that contextual factors such as the location of
the school and availability of easier alternative methods (walking, bus, etc.) would determine students
bicycle riding to school. Moreover, students were not aware of safety measures or traffic regulations
associated with bicycle riding and had almost no prior bicycle safety education. Promoting safety would
be a prerequisite for the local health department to increase physical activity through promoting bicy-
cle use. These insights are the community knowledge that is produced from the context of every-
day experiences of community members.
Discussion and Conclusions: Community knowledge from these two case studies explicitly show that
the communitys concerns for walking and bicycling go beyond the scope of the local health depart-
ments objectives for promoting physical activity. While positivist research paradigms argue that knowl-
edge creation is a neutral and value-free activity, it is only through the experience of the communi-
ty itself that valuable evidence can be created. Community knowledge provide the evidence-based
recommendations to develop, influence or modify a policy or project in order to maximize health gain
and minimize negative outcomes.
Keywords : Community knowledge, Participatory research, Physical activity
Contact Information:
Ms. Jinhee Kim
Seoul National University Graduate School of Public Health
1 Gwanak-ro, Gwanak-gu, Seoul 151-742, Korea
Phone : +82-2-880-2751
Fax: : +82-2-745-9104
E-mail: jeeny98@gmail.com
1005_ 2012-10-08 5:18 38
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
39
The potential health effects of climate change
on the elderly population in Korea
Yoon Shin Kim, Sung Won Yoon, Hyung In Jeon, Cheol Min Lee, and Joung Won Lee
Institute of Environmental & Occupational Medicine, Hanyang University Seoul, Korea (E-mail: yoonshin@hanyang.ac.kr)
Introduction: Weather-related health concerns have recently been issued in Korea because of the glob-
ally observed relationship between climate conditions and mortality changes in general population
group. Most of studies focus on an investigation of epidemiological and physiological evidence about
the range of health effects associated with hot weather, whereas research activities of relationship
between cold weather and heath of the vulnerable population group have been rather limited.
Especially, it has been proven that cold temperature or cold wave which is one of the key factors in
climate change event, has potential implications for the health of the elderly people. Although the aged
population in Korea rapidly increases, the relationship between climate change and their health
effects have not been well identified.
Method: We investigated the effects of winter temperature in Seoul, Korea on mortality of the elder-
ly population (ages 65+) during 1992-2007. To do this, we collected climate and death records data
from the Korea Statistics Agency and Korea Meteorological Center for the years 1992 through
2007. The study also estimated the future risks by employing the projections of the population in Seoul,
Korea and climate change scenario of Korea from 2011 to 2030.
Results: There appeared to be significant increases in mortality of 0.27%of total deaths, 0.52%of
respiratory disease, and 0.32%of cardiovascular disease, respectively, with decreasing of 1C in daily
minimum temperature based on past record.
Discussion and Conclusions: The limitation of this study was the impossibility in the prediction of daily
mortality counts. Therefore, daily death numbers could be predicted based on the future population
projection for Korea and the death records of 2005. Based on the results, cold weather effect on health
resulted from the climate was found to be significant. We concluded that the risk of mortality will increase
despite of an associated uncertainty in estimation of death counts. The details on differential effects
of climate change on sensitive populations including children and the aged population, and appro-
priate prevention and policy advocacy will be discussed at the presentation.
Keyworkds : climate changes, mortality, elderly people
Contact Information:
Dr. Yoon Shin Kim, , MPH, DrHSC, PhD
Prof. & Dirctor, Institute of Aging Society
Institute of Environmental & Occupational Medicine
Hanyang University, Seoul, Korea
Institute of Environmental and Industrial Medicine, Hanyang University, Seoul Korea
Phone : 82-2-2220-0692/ +82-2-2220-4041
E-mail: yoonshin@hanyang.ac.kr (O)/ yoonshin0301@hanmail.net (Personal)
1005_ 2012-10-08 5:18 39
40
| Korea Institute for Health and Social Affairs, Seoul, Korea
Health Impact Assessment of Settlement Re-devel-
opement: A Case from Low-income Area of Small City
in South Korea
Kwang Wook Koh
1
, Young Hyun Shin
1
, Jae Rak Ahn
2
, Young Sim Yun
3
1: Kosin University, Busan, Korea, 2: Gyeongsang University, Jinju, Korea, 3: Urban Space Design Institute. Co., Ltd, Changwon, Korea
Introduction: The rapid compressed urbanization of South Korea is unprecedented and re-devel-
opment of urban old village has been is recent sociopolitical agenda in south Korea cities and have
some notorious side effects. The purpose of this study was to know the subjective effects of old hous-
ing and village environment of Gangnam-dong in Jinju city, for minimizing the negative effect and
maximizing the positive effect of temporary house rotating re-developement of housing in low income
village of medium sized city.
Methods: Based on The Health Impact Assessment Guideline for Housing Environment Improvement
of Korean Institute for Health and Social Affairs and A Practical Guide for Health Impact Assessment
of New South Wales of Australia, literature review, various meetings(brain-storming, screening,
consulting and workshop) held in 2010. In addition to village inhabitant, people from Department of
planning, Public health center, Inhabitant self-regulation center participated. Health and urban plan-
ning professional from near regional university and organization including YMCA also participated
Results: In physical aspect, contamination of environment from wastes, bugs and traffic and sewage
raised first as problem. In social aspect, no meeting place for elderly, passenger safety and illegal park-
ing of cars in narrow street, insufficient lighting and crowding caused frequent quarrel among neigh-
bor and crime. In human health aspect, wide road obstructs the crossing to the river-side green area
and too big train noise in misty day cause stress, sparse outing due to dirty narrow alley cause phys-
ical inactivity and social isolation. Some unreasonableness and irrationality found in view of inhabi-
tants including housing repair cost and minimal area requirement for compensation of small land. Positive
effect derived about temporary house rotating re-developement of housing in low income village were
minimizing the destruction of existing infra, new employment, new open space and resettlement of
inhabitants. Negative effect derived was apprehension about external support
Discussion and Conclusions: Inhabitants need clearly about community based improvement includ-
ing hygiene, lighting and car parking etc. Specific policy and methods needs more refinement based
on community participation and empowerment. Temporary house rotating re-developement of
housing in low income village found to have many positive effect and some negative effect in view of
inhabitants
Keywords : re-developement, settlement, housing
Contact Information:
Professor Kwang Wook Koh
Kosin University
34, Amnam-dong, Seo-gu, Busan, 602-703 Korea
Phone : +82-51-990-6426
Fax: : +82-51-990-3036
E-mail: kwkoh@kosin.ac.kr
1005_ 2012-10-08 5:18 40
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
41
The Experience of Health Impact assessment of
Immunization Program in Jinju City, Korea
Keon Yeop Kim
1
So Youn Jeon
2
Man Joong Jeon
3
Kwon Ho Lee
4
Sok Goo Lee
5
Dongjin Kim
6
Eunjeong
Kang
7
Sang Geun Bae
1
JinHee Kim
8
1: Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu, Korea 2:Department of Emergency Medical
Technology, Daejeon Health Sciences College, Daejeon 3:Department of Preventive Medicine and Public Health, Yeungnam University College
of Medicine, Daegu 4:Department of Satellite Geoinformatic Engineering, Kyungil University, Gyeongsan 5:Department of Preventive Medicine,
Chungnam National University School of Medicine, Daejeon 6:Division for Health Promotion Research, Korea Institute for Health and Social
Affairs, Seoul 7:Department of Health Administration and Management, Soonchunhyang University, Asan 8:Institute of Health Science, Korea
University College of Health Science, Seoul, Korea
Introduction: The Jinju City in Korea launched free immunization program to remove geographical
and economic barriers to childhood immunization. The purpose of this study was to assess the
potential health impacts and improve the quality of the free immunization pro-gram in Jinju City by
maximizing the predicted positive health gains and minimizing the negative health risks.
Methods: A steering committee was established in September 2010 to carry out the health impact
assessment (HIA) and began the screening and scoping stages. In the appraisal stage, analysis of sec-
ondary data, literature review, case studies, geographic information systems analysis, a question-
naire, and expert consultations were used. The results of the data collection and analyses were
discussed during a workshop, after which recommendations were finalized in a written report.
Results: Increased access to immunization, comprehensive services provided by physicians, the
strengthened role of the public health center in increasing immunization rates and services, and the
ripple effect to other neighboring communities were identified as potential positive impacts. On the
other hand, the program might be inaccessible to rural regions with no private clinics where there are
more at-risk children, vaccine management and quality control at the clinics may be poor, and vac-
cines may be misused. Recommendations to maximize health gains and minimize risks were sep-
arately developed for the public health center and private clinics.
Potential impact on health Recommendations
Positive
Increased access to immunization
Increased immunization rate
Delivery of comprehensive health service at private clinics
Strengthened role of the public health center in increasing
the immunization rate and service coordination
Contribute to the national policy to reverse the low-birth
rate phenomena
Ripple effect to neighboring communities
Negative
Increased access limited to only some regions within Jinju
City
Possibility of poor management of vaccines
Low quality of health professionals
Misuse of vaccines
Recommendations to public health center
Reorient the role of the public health center for immuniza-
tion and develop administrative preparations
Develop strategies to increase booster immunization rates
Identify and include marginalized communities and popula-
tion groups
Prevent budget cuts in other welfare programs
Expand program to include elective immunization policy
Establish a monitoring system for program evaluation
Collaborate with other relevant sectors
Recommendations to private hospitals and clinics
Improve management of vaccines
Provide training for health professionals and strengthen
quality control measures
Develop a strategy in case of vaccine shortage
Include comprehensive health checkup service
Promote parents awareness of the elective immunization
policy
1005_ 2012-10-08 5:18 41
42
| Korea Institute for Health and Social Affairs, Seoul, Korea
Discussion and Conclusions: The HIA provided an opportunity for stakeholders to comprehensive-
ly overview the potential positive and negative impacts of the program before it was implemented.
An HIA is a powerful tool that should be used when developing and implementing diverse health-relat-
ed policies and programs in the community.
Keywords: Free immunization programs, GIS analysis
Contact Information:
Dr. Keon Yeop Kim
Department of Preventive Medicine, Kyungpook National University School of Medicine
101 Dongin 2, Jung-Gu, Daegu, Korea 700-422
Phone: +82-53-420-4863
Fax: +82-53-425-2447
E-mail: pmkky@knu.ac.kr
1005_ 2012-10-08 5:18 42
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
43
The Impact of Socioeconomic Environment on Local
Suicide Mortality: Evidence from a Spatial Analysis
Eunjeong Kang
1
, Hosung Shin
2
1: Soon Chun Hyang University, Asan, Korea; 2: Won Gwang University, Iksan, Korea
Introduction: Suicide mortality of Korea was 31 per 100,000 in 2009 and it has been the highest among
the OECD countries since 2007. Within the country, a wide variation in suicide morality has been observed.
The purpose of this study was to find out how socioeconomic environment factors are related to local
suicide mortality using a spatial analysis.
Methods: Age-standardized suicide mortality of 253 local government areas was obtained from the
National Statistics Office. Variables indicating socioeconomic environment of each local area includ-
ed percentages of high school graduates, population density, number of beds per 1,000, percent-
ages of single-parent households, percentages of rented housing, number of rooms per household
member, percentages of moving population, percentages of singles, divorce rate(%), percentages of
farmers, and percentages of population with chronic diseases. All data were of year 2010 and
obtained from the NSO. Geographical distributions of suicide mortality by sex were obtained using ArcGIS.
The existence of spatial correlations was tested using Morans I test. To analyze the relationship between
local suicide mortality and socioeconomic environment spatial analysis was used to consider the sig-
nificant spatial relations among local areas.
Results: The local suicide mortality of total population was negatively related to percentages of high
school graduates, population density and positively related to percentages of single-parent house-
holds, percentages of rented housing, number of rooms per household member, divorce rate, and num-
ber of chronic diseases. The local suicide mortality of males was negatively related to population den-
sity and positively related to percentages of sing-parent households, number of rooms per house-
hold member, divorce rate, and number of chronic diseases. The local suicide mortality of females was
negatively related to percentages of singles and positively related to percentages of rented housings,
number of rooms per household member, and divorce rate.
Discussion and Conclusions: Several socioeconomic environment factors were found significantly relat-
ed to local suicide mortality even after controlling geographical correlations.
Keyworkds : suicide mortality, spatial analysis, socioeconomic environment
Contact Information:
Dr. Eunjeong Kang
Department of Health Administration and Management
Soon Chun Hyang University
22 Soon Chun Hyang Ro, Shinchang-Myeon, Asan, 336-745 Korea
Phone : +82-41-530-1391
Fax: : +82-41-530-3085
E-mail: marchej72@gamil.com

































1005_ 2012-10-08 5:18 43
44
| Korea Institute for Health and Social Affairs, Seoul, Korea
Association of Part-Time Work and Suicide Attempts
among Korean Adolescent Students: a National Cross-
Sectional Survey
Sun-Jin Jo
1, 2
, Hyeon Woo Yim
1, 2
, Myung-Soo Lee
3
, Hyunsuk Jeong
1, 2
, Won-Chul Lee
1
1: Department of Preventive Medicine, College of Medicine, the Catholic University of Korea, Seoul, Korea
2: The Clinical Research Center for Depression of Korea, Seoul, Korea
3:Seoul Suicide Prevention Center, Seoul, Korea
Introduction: According to a recent meta-analysis study, occupation or employment status increas-
es the risk of suicide in adults. However, there exist few studies investigating the association between
in-school students part-time work and suicide attempts.
Methods: This study analyzed Korean Youth Risk Behavior Surveillance data (2008) including 75,238
samples that represent Korean middle and high school students. Logistic regression analysis was per-
formed to investigate the association of part-time work and suicide attempt during past 1 year con-
trolled by socio-demographic, school-related, life-style, and psychological factors.
Results: There was no association between part-time work and suicide attempt after socio-demo-
graphic, school-related, life-style, and psychological factors were controlled among high school
students. But as to middle school students, part-time work was associated with suicide attempt sig-
nificantly. (OR=1.59, 95%CI: 1.37-1.83)
Discussion and Conclusions: Middle school students part-time work may increase their suicide attempt
in Korea. It is suggested that social and legal environments related with adolescents labor need to
be reviewed for prevention of their suicide attempt.
Key words : Adolescent, Work, Suicide
Contact Information:
Dr. Sun-Jin Jo
Department of Preventive Medicine, College of Medicine, the Catholic University of Korea
505 Banpo-dong, Seocho-gu, Seoul, 137-040 Korea
Phone : +82-2-2258-7366
Fax: : +82-2-532-3820
E-mail: jiny4u@catholic.ac.kr
1005_ 2012-10-08 5:18 44
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
45
Health Impact Assessment Capacity Development in
Vietnam
Nguyen T.L.H
1
, Ton T.N
2
1: Health Environment Management Agency, Ministry of Health, Vietnam
2: World Health Organization Representative Office in Vietnam, Hanoi, Vietnam
Introduction: In the period of 2005 - 2009, the Health Environment Management Agency (HEMA)
of the Ministry of Health, together with partners of the World Health Organization (WHO) and the Capacity
Building International, Germany (InWEnt), the DBL Centre for Health Research and Development of
the Faculty of Life Sciences, University of Copenhagen (Denmark) were engaged in intersectoral Health
Impact Assessment (HIA) capacity building in Vietnam. Since 2009, HEMA in co-operation with
WHO and Ministry of Natural Resources and Environment (MoNRE) has continued to conduct capac-
ity building in HIA and step by step set up a foundation for development of HIA process in Vietnam
through the proposal of National Environmental Health Action Plan (NEHAP). However, a lot of
efforts and commitment from related stakeholders are needed to insitutionalize HIA process.
Methods: A literature review method was used. A discussion with partners (WHO, MoNRE) was con-
ducted to get an overview of the whole process of HIA development in Vietnam.
Results: In retrospect the activities have included:
1) A National Workshop on Health Impact Assessment addressing HIA principles and practice
for a target group of Ministry of Health staff (Do Son, October 2005);
2) A Workshop on Development of a Training of Trainers Course Curriculum on HIA (Hanoi,
November 2006);
3) A Course on Training-of-trainers for HIA Capacity Building (Da Nang, Sept. 2007);
4) A Technical Briefing Workshop on Health Impact Assessment, (Hanoi, November 2007).
5) A Joint HIA Orientation and Refresher Course (Ha Long, May 2008).
6) A pilot HIA training course at provincial level (Ba Ria Vung Tau, October 2008).
7) A training material of HIA developed for provincial health and environment staff (Ha Noi,
September 2011)
8) HIA issues were discussed and put into the draft proposal of NEHAP during technical working
group meetings (2010, 2011)
1005_ 2012-10-08 5:18 45
46
| Korea Institute for Health and Social Affairs, Seoul, Korea
9) Two Training courses on HIA for provincial health and environment staff (Nha Trang, October
2011 and Quang Ninh, November 2011).
10) A Guideline on HIA for development projects has been under development by HEMA with WHO
support.
Discussion and conclusions: Through a series of training activities in the capacity building for HIA,
a pool of key trainers in HIA including focal staff in MoH and MoNRE has been established to serve
for further trainings at national and provincial levels. Awareness on HIA in healthcare and environ-
mental staff at all levels has been improved. There have been co-operation between MoH and
MoNRE in developing NEHAP. However, all those efforts seem to be not enough to facilitate insitu-
tionalization of HIA process. Building HIA process requires not only efforts, commitments and patience
but also an appropriate approach and a long vision.
Key words: HIA, capacity building, Vietnam
Contact Information:
Nguyen Thi Lien Huong
General Deputy Director of Health Environment Management Agency, Ministry of Health
Alley 135 Nui Truc, Ba Dinh district, Ha Noi city, Vietnam
Phone: +84 4 37368392
Fax: +84 4 37368394
Email: huongtl.nguyen@gmail.com
1005_ 2012-10-08 5:18 46
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
47
P.R.Prak
1
, S.Kong
2
, E.M Khoung
3
1 Director Preventive Medicine, Ministry of Health, Cambodia; 2 Calmette Hospital, Phnom Penh, Cambodia; 3 Deputy director Preventive
Medicine, Ministry of Health, Cambodia
MultisectOral PARTICIPATORY APPROACH FOR
HEALTH IMPACT ASSESSMENT IN CAMBODIA
OVERVIEW
Increase urbanization - plan to respond to changing lifestyles
Increase in environmental risk factors - air, water and soil contamination as well as other risk
factors associated with the built environment
Process of socio-economic development use naturaland human resources to serve for the
development
The impact both to health and discharged pollution and hazardous waste to the environment
These factors are contributing to an increase in both communicable diseases, non-commu-
nicable diseases and injuries, poor nutrition and mental ill-health
Emerging environmental health issues - global climate change presents new challenges
Threats of serious or irreversible damage to the environment
HIA offers a practical and flexible framework for identifying health and equity impacts and ways
of addressing them
PRIORITY INTERVENTION
Effective establishment of inter-sectoral and inter-disciplinary working group
Implement measures that ensure public participation in the HIA process including full access
to relevant information
Optimal openness and great proclivity to participation by the communities involved
Apply screening criteria to the policy, program, project or plan. Determine whether an HIA is
required
Selected developmental projects that
required EIA & HIA :
- constructing tower/new city,
- coal power/ hydropower/fuel power plant,
- mine
- heavy industries, biogas plant
- hazardous waste incineration plant,
- agriculture and plantation
1005_ 2012-10-08 5:18 47
48
| Korea Institute for Health and Social Affairs, Seoul, Korea
HEALTH ISSUES NEED TO BE ADDRESSED
Construction
Health of workers and communities from construction work especially dust, noise, traffic
Disease surveillance established for injuries, respiratory diseases, vector and water borne dis-
eases
Operation
Potential pollutants associated with discharges from the plant to the air, water and soil
Disease under surveillance are cancer, congenital deformities, respiratory diseases, skin dis-
eases etc.
Social and welfare of the workers
Challenges
Socio-economic growth within Cambodia can have both positive and negative impacts on the
environmental and social determinants of health
RGC not realize as priority issue
Difficulties in agreement dialogue, decision-making and resolving conflicts among different
partners in the process
Extremely high degree of socio-political health and environmental complexity
The procedures of the EIA is not include HIA
HIA policy still in the process of approval by the National Committee for Environmental health
Neediness capacity on HIA among health professionals
WAY FORWARDS
Advocacy for political commitment
Institutional arrangements
Select the appropriate assessor and appraisal of HIA statement
Institutional regulation and compliance of the HIA process
Inter-sectoral capacity building of government and non government HIA regulators and prac-
titioners
Public participation in the HIA process including full access to relevant information
Negotiation with final choice of options for health risk management
Ongoing inter-sectoral capacity building of government and non government HIA regulators
and practitioners is seen as strategically important
Encourage and assist as required the development of an association of HIA professionals with-
in the country to further enhance capacity building.
Implement measures that ensure public participation in the HIA process including full access
to relevant information.
Ensure wider reaching collaboration of HIA practitioners within the region
Contact Information:
Dr. Prak Piseth Raingsey
Director
Preventive Medicine department
Ministry of Health
#151-153, Blvd. Kampuchea Krom,
Phnom Penh, Cambodia
Phone : (855)12862022
email: pisethsey@yahoo.com
1005_ 2012-10-08 5:18 48
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
49
Determination of Environmental Factors that
Influenced Cholera Outbreak in Catanduanes Province,
Philippines
Maria Sonabel S. Anarna
1
1: Department of Health, Philippines
Introduction: On June 2012, the Department of Health (DOH) declared a province-wide outbreak of
cholera in Catanduanes, Philippines. The outbreak resulted in 2,021 cholera cases and 14 validat-
ed fatalities according to the Catanduanes Health Update No.17 as of 10 July 2012. Catanduanes is
the 12th largest island in the Philippine Archipelago occupying an area of 1,511.5 square kilome-
ters and the smallest among the six provinces that constitute the Bicol Region. With the DOH out-
break declaration, the DOH & WHO Philippines formed a mission team that included the Local Water
Utility Authority (LWUA). The purpose of the mission was to determine the environmental factors that
influence the cholera-stricken health condition of the populations of the province. The investigation
focused on the aspects of water, sanitation and hygiene (WASH).
Methodology: The assessment comprises of the following activities in the field: site visits of five barangays
in two municipalities of Catanduanes, interview with the households and local leaders, and review of
local reports. During the site visit, the water supply and sanitation systems used by the populations
were given emphasis. For the one-on-one interview with the respondents, key questions were
asked on their hygiene practices and health-seeking behavior.
Results: The findings of the assessment endeavor identified the following factors that could have influ-
enced the cholera outbreak of the province: open defecation practices, absence of chlorination in water
systems, poor water source protection, absence of regular water quality monitoring, uncontrolled dis-
posal of garbage and wastes from backyard piggery and poultry, and the location of affected areas
wherein several confirmed cholera cases were along the rivers and shorelines with high population
density.
Discussion and Conclusions: There were times during the outbreak that diarrheal cases in the
affected areas were decreasing in its trend, but there is no assurance that the upsurge in cases may
not happen again unless the identified risk factors are given preferential attention for intervention.
Keywords : cholera, environmental factors
Contact Information:
Engr. Maria Sonabel S. Anarna
Department of Health
San Lazaro Compound, Sta. Cruz, Manila
Philippines
E-mail: masonabel@yahoo.com
Reference: Mission Report on the Cholera Outbreak Assessment for water, sanitation and hygiene con-
ducted on July 2012 by the mission team- Bonifacio Magtibay (WHO Philippines), Maria Sonabel S.
Anarna (DOH), Virgilio Bombeta, Edison Cuenca, and Arturo Fernando (LWUA).
1005_ 2012-10-08 5:19 49
50
| Korea Institute for Health and Social Affairs, Seoul, Korea
Health Impact Assessment in Mongolia
Tsetsegsaikhan Batmunkh
Ministry of Health, Ulaanbaatar, Mongolia
Introduction: Mongolia is currently going through a period of increased economic activity with the
recent unveiling of some of the largest mineral deposits in the world. The growth of financial mar-
kets is accompanying the rapid development in the mining industry and agriculture. The incorpora-
tion of Health Impact Assessment (HIA) with the current existing Environmental Impact Assessment
(EIA) will be important in protecting the health of the population during this period of economic growth.
Results: Mongolia established EIA legislation and the processes regulating this assessment in the Law
on EIA from 1998. The Law was renewed in 2012 and particularly new issues, such as strategic impact
assessment and health impact assessment were included. The Law states that the Procedures on
conducting an examination on Detailed Environmental Assessment need to be approved by
Government Resolution, taking into account health and social impacts.
Conclusion: Legal integration of HIA within the current EIA process will provide an effective mech-
anism for establishing comprehensive HIA structures and avoiding health impacts in the early stages
of project development. To implement best practice HIA there is an urgent need for capacity build-
ing amongst health sector professionals, developing appropriate detailed guidance on the ways to
conduct assessment.
Key words: health impact assessment, environmental impact assessment
Contact Information:
Tsetsegsaikhan Batmunkh
Public health policy coordination and implementation department
Ministry of Health
Government building VIII, Olympic street-2
Ulaanbaatar, Mongolia
Phone: 976-51-263925
E-mail: tsetsegsaikhan@moh.mn, tsetsegsaikhan@yahoo.com
1005_ 2012-10-08 5:19 50
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
51
Health in EIA : Thailands Experiences
Siriwan Chandanachulaka.
Siriwan Chandanachulaka. Health Impact Assessment Division, Department of Health, Ministry of Public Health, THAILAND
Introduction: Environmental Impact Assessment system in Thailand had launched since 1981 about
31 years ago, as a part of permit approval. It is responsible by the Ministry of Natural Resources and
Environment. It has been changed in terms of regulation, number of projects that shall conduct EIA,
consideration procedure and support system. Types of project/activity to conduct EIA had increased
from 10 to 34 types of projects/activities with 11 special types of projects that have to conduct envi-
ronment and health impact. However, it seems that health in the EIA is not well assessed and stat-
ed. This project aims to collect and analyze 10 EIA reports and to provide notifications and recom-
mendations.
Methods: Ten different types of EIA reports conducted during 2011-2012 were selected. Then
researchers collected data according to details provided by the reports, follows by analyzing the data.
Finally, suggestions and recommendations were provided.
Results: Health in the EIA reports shown in the current situation. Almost of them are numbers of health
facilities, health personnel, number of in-patient or our patients according to 21 groups of diseases
in that province or district or sub-district, 10 leading cause of deaths. For the assessment of health
impact some shown in separated section in the report, methodology they use for assessing health
impact is mainly Qualitative Health Risk Matrix. It is noticed that occupational health and safety did
very well in the assessment in all ten reports. However, community health impacts are not well
assessed.
Discussions and Conclusions: One area of health that is most developed is in EIA is occupational health
and safety. It means that almost of workers are well protected through policy, measures specific for
each site, while community health need further developed. There are opportunities to expand from
within each factory to cover health of the people in communities.
Key words: EIA, health, Thailand
Contact Information:
Ms Siriwan Chandanachulaka
Director of Health Impact Assessment Division, Department of Health Ministry of Public Health, Nontaburi
Province, 11000, THAILAND
Phone +66-2-590-4342 Fax +66-2-590-4356
E-mail: siriwan9@gmail.com
1005_ 2012-10-08 5:19 51
52
| Korea Institute for Health and Social Affairs, Seoul, Korea
Integration of HIA into the EIA report in Vietnam
PHAM Hoai Nam
Department of Appraisal and Environmental Impact Assessment, Ministry of Natural Resources and Environment, Vietnam
EIA in Vietnam
-Tool for environmental planning and management
-Impacts identification of project investments
-Establishment of appropriate mitigation measures
The natural resources will be efficiently used for the economic development
EIA law and regulations
-Law on Environmental Protection 2005
-Decree No. 29/2011/ND-CP of the government on strategic environmental assessment,
environmental impact assessment, and environmental protection commitments
-Circular No. 26/2011/TT-BTNMT of Ministry of Natural Resources and Environment (MONRE)
on detailed guidelines for some articles of Decree No. 29/2011/ND-CP
Decree No. 29/2011/ND-CP:
-143 types and sizes of projects required EIA
-Industry (industrial parks, power plant, cement factories, sugar mills), agriculture (irriga-
tion), transportation (airport, expressway, port), mining, public health (hospital, pharmaceutical
companies), tourism (hotel, resort, golf course)
Integration of HIA into the EIA report
Law on Prevention and Control of Infectious Diseases 2007:
-Investment projects on construction of industrial parks, urban centers, residential areas or
infectious disease examination and treatment establishments can be executed only after their
health impact assessment reports have been appraised by competent health agencies
Article 17, Decree No. 29/2011/ND-CP:
-Assess and predict project's impacts on natural conditions, natural environment, community and
related socio-economic factors; community consultation results;
-Propose measures to mitigate negative environmental impacts to the natural conditions, pub-
lic health and involved socio-economic factors
1005_ 2012-10-08 5:19 52
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference(Seoul, Koera) |
53
EIA report:
-Health issues are only mentioned in general, with the risk of illness, such as: population explo-
sion, increases in social vices, traffic accidents, alcohol abuse
-No report refers a specific action plan to limit and overcome the health risks
Need for integrating HIA into EIA:
-Health risks should be studied more clearly to establish the distinct prevention and mitigations
measures
-Decision making should consider in all aspects including economic, engineering, environmen-
tal, health and social aspects
-New regulation demands that every investment projects required EIA must be appraised and
approved HIA report
-HIA general guideline must be issued by Ministry of Health and Ministry of Natural Resources and
Environment
-In EIA report, steps in HIA implementation must be clear and conducted by HA specialists
Contact Information:
Hoai Nam PHAM, PhD
Department of Environmental Impact Assessment
Vietnam Environment Administration
Ministry of Natural Resources and Environment
10 Ton That Thuyet (A1802), Cau Giay, Ha Noi, Viet Nam
Mobile: +84 (0) 982 037 555
1005_ 2012-10-08 5:19 53
1005_ 2012-10-08 5:19 54
1005_ 2012-10-08 5:19 55
Location Map
Address Jinhungro235, Bulgwang-dong, Eunpyeong, Seoul 122-705 Korea
Tel (+82-2)380-8000
Fax (+82-2)352-9129, 2181
235
Map
.RRNPLQ%DQN
:RRUL%DQN
:RRQJMLQ
.:',
.(,
jgyjgQJ,
1,+
+RQJMLH
.)'$
&KRKXQJ%DQN)
[[JJ[J[jJT
,
@

g
y

j
g

j
The 4
th
Asia and Pacific Regional Health Impact Assessment Conference
and Workshop for Health Impact Assessment in Southeast and East Asian Countries
Date : October 9-11, 2012
Venue : Korea Institute for Health and Social Affairs, Seoul, Korea
Website : http://hia.kihasa.re.kr/eng
1005_ 2012-10-08 5:16 1