Health impact assessment in urban settings

Health impact assessment is being used to support and deliver healthy and sustainable communities in major urban areas around the world. This article discusses some of the latest international developments in the use of health impact assessment in urban settings: in North America, Europe, Africa, Asia and Australasia. It outlines the implications of this work and describes some of the challenges facing practitioners in predicting health impacts and providing solutions to protecting and enhancing health and wellbeing in urban settings. Salim Vohra Centre for Health Impact Assessment, Institute of Occupational Medicine, UK Email: salim.vohra@iom-world.org North America Unlike the USA, Canada has a longstanding record in the field of HIA, healthy public policy and the consideration of the health impacts of policies, plans, programs and projects.3,4 Only in the last few years has HIA gathered momentum in the USA, with the growing recognition that health and wellbeing are critical issues for major urban areas.5 Leading institutions, notably the Centers for Disease Control and Prevention (CDC) in Atlanta, have begun to carry out HIAs on urban development plans and projects.6–8 One example of the imaginative work happening in North America is the work of the Design for Health initiative. This collaboration between the Metropolitan Design Center at the University of Minnesota and Blue Cross and Blue Shield of Minnesota, two major health insurance associations, aims to bridge the gap between community design, healthy living and land development planning.9 The Design Center’s work is done by an interdisciplinary team with backgrounds in architecture, landscape architecture, planning, public health and landscape ecology. They have created a HIA tool and a set of HIA materials and information for other agencies and organisations in Minnesota to use when developing new urban plans and projects. Europe HIA has been practised in Europe for almost a decade with the UK, Finland and the Netherlands among others being major proponents.10 In Europe the major driving forces for the way HIA is being used in urban settings have been the health inequalities, sustainability and climate change agendas. One example of the leading edge HIA activity in Europe is the work of the London Healthy Urban Development Unit. This Unit is investigating the links between urban planning and health and has developed a range of HIA tools to help improve health and wellbeing in London.11 Their financial model is the first of its kind internationally to estimate the capital and revenue costs of health-care services for new housing developments and extensions to existing urban areas. It is also pioneering the use of Geographical Information Systems to map existing health, social, leisure and cultural facilities and plan the situation of new facilities to ensure that they are evenly distributed and accessible to all.