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Health Impact Assessment and the ASEAN Challenges. Decharut Sukkumnoed Kasetsart University and Healthy Public Policy Foundation, Thailand. Introduction.
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Health Impact Assessment and the ASEAN Challenges Decharut SukkumnoedKasetsart University andHealthy Public Policy Foundation, Thailand
Introduction • The importance of inter-sectoral commitment and action, or “All for Health” principle, has been hi-lighted, since the 1st International Conference for Health Promotion (1986). • However, the 5th ICHP found that “high-sounding, general calls to improve social responsibility for health are not sufficient to stimulate action” (2000). • After 1990, globalization has introduced adverse effects and new opportunities for health communities. • In Bangkok Charter 2005, How HIA can address the globalization challenges, through the formulation of healthy public policy and re-oriented globalization with a more healthy human face.
Healthy Public Policy • The capacity of society to screen, analyze, select, develop, nurture, and influence public policies to protect and promote health is needed. • HPP aims to create supportive environmental framework to enable people to lead healthy lives. • The core idea is to “put health on the agenda of policy makers in all sectors and at all levels” and to “make healthier choices the easier choices” for policymaking. • HPP is the bridge for integrating health dimension into upstream development process and empowering people to have more control over their health, lives and destinies.
Health Impact Assessment • A commitment to HPP means the government must assess and measure the health impacts of their policies in a consultative and participatory ways. • HIA=“a combination of procedures, methods, and tools by which a policy, program, project may be judged as to its potential effect on health of the population and the distribution of those effects within the population.” • HIA provides “a set of evidence-based recommendations gears to informing decision-making process”. • The aim of HIA is to “achieve changes in policies and proposals so that they support better health and reduce health inequalities”.
HIA and Health Promotion • HIA provides a mechanism to achieve the engagement of other sectors in health promotion, through the assessment of and the recommendation for inter-sectoral actions. • HIA needs to address health determinants upstream in planning process. • HIA helps identify and protect disadvantage and vulnerable groups in the societies. • HIA can show how healthier policy solutions are also more attractive social investment options. • HIA = the window for health sector to participate more pro-actively and meaningfully in wider public spheres.
Methodological Development • The development of two main approaches; • EIA approach (Project-oriented approach)more bio-medical model of health(bio-physical determinants of health) • HPP approach (Policy-oriented approach) more socio-environmental model of health(wider determinants of health) • HIA method applies a wide variety of tools, such as reviews, epidemiological studies, mapping, etc. • It is still difficult to determine the most appropriate combination of tools for a specific setting. • It is a need for further methodological development, to make it both “universally accessible” and appropriate for “any groups” of HIA practitioners
Underpinning Principlesof HIA • Democracy • Equity • Ethical Use of Evidence • Practicability • Collaboration • Comprehensiveness • Sustainability
Reduction in Greenhouse gas Emission Reduction by 40%
Reduction in Air Pollution (SOx) SOxReduced by50%
Better Urban Zoning ร่างผังฉบับใหม่ (กันยายน 2553)
Field Experiment บึงบัวข้างนิคมฯ “หนองแฟบ”ในตำนาน 1 ป่าชายเลนผืนสุดท้าย
Policy Options ร่างผังเมืองทางเลือกฯ ร่างผังเมืองฉบับใหม่ (กันยายน 2553) กลายมาเป็นร่างผังเมืองทางเลือกเพื่อสุขภาวะ
Healthy Urban Zoning: Reduction of Potential Air Pollutant Emission (ton/day)
Healthy Urban Zoning:Reducing Water Consumption and Water Discharge (m3/day)
Is HIA applied mainly for the approval of policy or project?
HIA Learning Process:Participatory Learning Process • Pesticide Risks- Health Impacts- Local eco-system- Economic impacts- Study Visits- Local Development Plan
HIA Learning Process:Study Visits Finding alternativesLearning new practicesComparing impacts Designing the Future
HIA and Policy-making • The early version of HIA assumed a linear process with a direct link between HIA and decision-making process.“without real consideration of the political and administrative frameworks within which is has to operate” • The later version of HIA tended to emphasize decision-making structures and political process. • Several HIA studies can successfully influence policy-making. The keys to success are strong political commitment, participatory processes, and finding effective ways in fitting non-statutory assessment into statutory planning (or policy) framework. • The success of HIA should not necessarily be evaluated as a one-off event, but more as “a continual effects that bring change in organizational thinking about health and subsequent decision-making”.
HIA Institutionalization • Institutionalization, or how to integrate HIA into existing procedures and roles of policy-making, is crucial to create a firm basis for HPP. • Becoming a routine part of policy-making without appropriate design and quality control can make HIA an inefficient process with merely a symbolic function. • HIA institutionalization have taken place in different countries. The best institutionalization strategy depends very much on political, administrative, economic contexts of each country. • To improve and maintain HIA effectiveness in policy system, it is necessary to design and invest in quality control mechanism, adequate provision for external accountability and technical support systems.
HIA= Social Learning Process • HIA has not been developed as another technical tool but rather as a tool for social learning. • The opportunities for public involvement is the main advantage of HIA as a health promotion tool. • The HIA process can promote the sense of self-esteem and responsibility. • HIA can also work as a conflict resolution mechanism and provide room for marginalized groups to raise societal concerns over their health and destinies. • HIA process enables non-health actors to generate relevant public health knowledge and also re-orient power relationship with and between professional decision-makers.
Yes. In EU, they applied HIA for common agricultural policy and other EU policies.
Regionalization and Health • Regionalization can stimulate economic growth, reduce the sense of isolation, bring technological advancement, better infrastructure and educational progress and raise concerns on environment and human rights. • Regionalization, just like globalization may cause the difficulties for the government in safeguarding people’s socio-economic conditions, increases the pressures on natural resources and environment, changes lifestyles and social structures, and leads to social and cultural tensions. • Regionalization also affects ability of health sectors in taking care of their populations, through the adjustment of macro-economic policy framework.
Some Emerging Topics for Collaborative HIAs in ASEAN • Climate change adaptation • Flood Management in ASEAN cities • ASEAN economic corridors • Mekong river basin management • Long-term food security • Food standard harmonization • ASEAN Cross-border health services • Healthy generation of ASEAN (youth) • Etc.
HIA & the ASEAN Challenges • HIA provides a fertile ground for nurturing our societal capacities in developing HPP. • At the national level, the appropriateness of its implicit strategies, such as institutionalization and empowering social learning process, in each contexts will determine the ultimate success of HIA. • At the regional level, the number of international policies and mega-project investment should be reconsidered through HIA. • The strategy to link HPP & HIA with ASEAN development goal is necessary to re-orient regional development process. • The strong aspiration of “living healthily together” with supportive academic collaborations is essential for HPP & HIA development in ASEAN countries.
