From Treatment to Prevention Health Impact Assessments as a toll for urban management

1. From Treatment to Prevention Health Impact Assessments as a toll for urban management Dr Carlos Dora Former Coordinator - Department of Public Health and Environment - World Health Organization, Geneva Professor Global Environmental Health Governance – Columbia University, New York Key messages for mini-campaign

2. What is the health performance of the city you want to build? How do urban policies and investments: • prevent diseases and premature death among all citizens • enhance child development and enable older people to keep active and functional • creates opportunities for social interaction and quality of life

3. How cities affect your body? e.g. air pollution, diets and physical activity affects the vascular system causing strokes, heart attacks, lung diseases, dementia Physiopathology e.g. calcification of artery walls

4. Extensive evidence about health benefits and risks from urban policies • Access to healthy: • housing • transport • green areas • public space • foods • buildings • energy • WatSan • clean air

5. Healthy transport: rapid transit, cycling and walking • Reduce air pollution • Increases physical activity • Reduces traffic injury • Frees urban road/parking for green /public space • Facilitates more equitable access to goods and services • Eases movements of older people, children, disabled, women • Promotes social cohesion in local communities

6. Housing: temperature, ventilation, safety (falls) « Improved insulation saved 0.26 months of life per person » (UK Warm Front Programme) Reduction of respiratory illness by 9% to 20% and increase of individual productivity between 0.48% and 11% with natural ventilation startegies Photo 1 (graphic, table, map, etc) zone « Reduced wheezing, days-off school, doctors' visits were reported by occupants of insulated homes «  (NZ Insulation study)

7. Access to healthy foods Lesssugar Less fat, More vegetables, fruits and nuts, Less: Obesity, Cardio-vascular d. Cancer

8. Access to public and green spaces • Encourage physical activity • Shady areas can reduce the "heat-island" effect in urban area • Green spaces have important psychosocial benefits • Trees and vegetation absorb some air pollution • Can separate people from pollution sources (highways)

9. Solutions: Support Policies with Health benefits, Health impacts: Falls Dementia, Heart disease Stroke Respiratory cancer Injuries, Air pollution, noise Physical activity, diet Functionalcapacity Mental health Social interaction

10. Quickly establishes "health relevance" of the policy or project. Is HIA required? Screening Policy, programme , or project development phase for prospective assessments. Identifies key health issues & public concerns, establishes ToR, sets boundaries. Scoping Rapid or in-depth assessment of health impacts using available evidence – who will be affected, baseline, prediction, significance, mitigation. Appraisal Conclusions and recommendations to remove/mitigate negative impacts on health or to enhance positive. Policy or project implementation phase Reporting Action, where appropriate, to monitor actual impacts on health to enhance existing evidence base. Monitoring HIA procedure

11. How is health influenced by transport? (Watkiss et al, 2003)

12. Urban Health InitiativeCatalyzing Change

13. Levels of urban transformation Urban leaders act - changes in policies, air quality, climate & health indicators are tracked Communications intensify demands for change Alternative scenarios tested – vision for healthy urban future articulated Tools for assessing health and economic benefits Health policymakers build competencies Current policies and stakeholders assessed and mapped

14. Current urban policies and stakeholders assessed and mapped Current policies with major impacts on health are mapped along with key stakeholders in urban health and urban development sectors and civil society

15. Health professionals build competencies Health policymakers build competencies in assessing health and economic impact of policies and in advising other sectors on urban environmental health risks. Health care workers equipped to advise patients on protective measures

16. Tools for assessing health and economic benefits Tools for assessing health and economic arguments such as WHO’s AirQ+, HEAT and One Health adapted and used locally. Tools for front line health care workers to advise patients & communities HIA AirQ+ HEAT Health economicassessmentfor walking/cycling

17. Alternative scenarios assessed and tested Alternative scenarios based on policy options tested or considered locally to estimate potential health and economic impacts

18. Transport scenarios for Sao Paulo, Brazil: Changes in DALYs for each scenario attributable to changes from air quality, physical activity and road injuries Sá et al. 2017

19. Communications intensify demands for change Urban leaders and champions engaged to communicate costs of inaction, including thorough global BreatheLife Campaign, intensifying demand for action. Health care workers advise patients & communities about prevention

20. Urban leaders act - changes in air quality, climate & health indicators monitored and tracked Health and economic arguments provide urban leaders with incentive to act; changes in air pollution and related policies monitored and tracked, using WHO Global Urban Ambient Air Pollution Database Designed by Inis Communication • Illustration elements from www.freepik.com

21. Visualize a healthier future Track progress in the trajectory