Lea den Broeder

Emphasising enhancement in all forms of impact assessment : introduction to a special issue

In the context of impact assessment (IA), ‘enhancement’ refers to deliberate attempts taken in the design and subsequent phases of projects, programmes, plans and policies to ensure the success of a wider range of direct and indirect positive outcomes to communities and/or the biophysical environment. This can be in the form of opportunities for social and community development, improved health and wellbeing, improved biodiversity, restored ecosystems and landscape character, and protected and respected cultural heritage. This first ever special issue on enhancement advocates that all forms of IA should consider opportunities for enhancement. Specific reference is made to strategic environmental assessment (SEA), environmental impact assessment (EIA), social impact assessment (SIA) and health impact assessment (HIA). The paper presents views from IA practitioners regarding perceptions of the barriers to greater use of enhancement in IA and suggestions for possible solutions to those barriers. Investment in enhancement initiatives contributes to sustainable development and resilience, and is consistent with corporate social responsibility obligations of proponents.

Citizen Science for public health

Abstract Community engagement in public health policy is easier said than done. One reason is that public health policy is produced in a complex process resulting in policies that may appear not to link up to citizen perspectives. We therefore address the central question as to whether citizen engagement in knowledge production could enable inclusive health policy making. Building on non-health work fields, we describe different types of citizen engagement in scientific research, or ‘Citizen Science’. We describe the challenges that Citizen Science poses for public health, and how these could be addressed. Despite these challenges, we expect that Citizen Science or similar approaches such as participatory action research and ‘popular epidemiology’ may yield better knowledge, empowered communities, and improved community health. We provide a draft framework to enable evaluation of Citizen Science in practice, consisting of a descriptive typology of different kinds of Citizen Science and a causal framework that shows how Citizen Science in public health might benefit both the knowledge produced as well as the ‘Citizen Scientists’ as active participants.

Resident participation in neighbourhood audit tools — a scoping review

Abstract Background Healthy urban environments require careful planning and a testing of environmental quality that goes beyond statutory requirements. Moreover, it requires the inclusion of resident views, perceptions and experiences that help deepen the understanding of local (public health) problems. To facilitate this, neighbourhoods should be mapped in a way that is relevant to them. One way to do this is participative neighbourhood auditing. This paper provides an insight into availability and characteristics of participatory neighbourhood audit instruments. Methods A scoping review in scientific and grey literature, consisting of the following steps: literature search, identification and selection of relevant audit instruments, data extraction and data charting (including a work meeting to discuss outputs), reporting. Results In total, 13 participatory instruments were identified. The role of residents in most instruments was as ‘data collectors’; only few instruments included residents in other audit activities like problem definition or analysis of data. The instruments identified focus mainly on physical, not social, neighbourhood characteristics. Paper forms containing closed-ended questions or scales were the most often applied registration method. Conclusions The results show that neighbourhood auditing could be improved by including social aspects in the audit tools. They also show that the role of residents in neighbourhood auditing is limited; however, little is known about how their engagement takes place in practice. Developers of new instruments need to balance not only social and physical aspects, but also resident engagement and scientific robustness. Technologies like mobile applications pose new opportunities for participative approaches in neighbourhood auditing.

Local professionals’ perceptions of health assets in a low-SES Dutch neighbourhood: a qualitative study

BackgroundAsset-based approaches have become popular in public health. As yet it is not known to what extent health and welfare professionals are able to identify and mobilise individual and community health assets. Therefore, the aim of this study was to understand professional’s perceptions of health and health assets.MethodsIn a low-SES neighbourhood, 21 health and welfare professionals were interviewed about their definition of health and their perceptions of the residents’ health status, assets available in the neighbourhood’s environment, and the way residents use these assets. A Nominal Group Technique (NGT) session was conducted for member check. Verbatim transcripts of the semi-structured interviews were coded and analysed using Atlas.ti.ResultsThe professionals used a broad health concept, emphasizing the social dimension of health as most important. They discussed the poor health of residents, mentioning multiple health problems and unmet health needs. They provided many examples of behaviour that they considered unhealthy, in particular unhealthy diet and lack of exercise. Professionals considered the green physical environment, as well as health and social services, including their own services, as important health enhancing factors, whereas social and economic factors were considered as major barriers for good health. Poor housing and litter in public space were considered as barriers as well. According to the professionals, residents underutilized neighbourhood health assets. They emphasised the impact of poverty on the residents and their health. Moreover, they felt that residents were lacking individual capabilities to lead a healthy life. Although committed to the wellbeing of the residents, some professionals seemed almost discouraged by the (perceived) situation. They looked for practical solutions by developing group-based approaches and supporting residents’ self-organisation.ConclusionsOur study shows, firstly, that professionals in the priority district Slotermeer rated the health of the residents as poor and their health behaviour as inadequate. They considered poverty and lack of education as important causes of this situation. Secondly, the professionals tended to talk about barriers in the neighbourhood rather than about neighbourhood health assets. As such, it seems challenging to implement asset-based approaches. However, the professionals, based on their own experiences, did perceive the development of collective approaches as a promising direction for future community health development.

We are all experts! Does stakeholder engagement in health impact scoping lead to consensus? A Dutch case study

Abstract Stakeholder engagement in Environmental Impact Assessment (EIA) and Health Impact Assessment (HIA) provides opportunities for inclusive environmental decision-making contributing to the attainment of agreement about the potential environmental and health impacts of a plan. A case evaluation of stakeholder engagement was carried out to assess its effect in terms of consensus-building. The case consisted in two health impact scoping workshops engaging 20 stakeholders: policy-makers, experts and residents. A Participatory Action Research approach was adopted. Methods included observation, semi-structured questionnaires and interviews. Analysis methods consisted of several coding rounds, in-depth reading and discussion of Atlas.ti output reports, as well as studying questionnaire results. Participants reported a broadening of perspectives on health in relation to the environment and attainment of shared perspectives. Still, meaningful differences remained, indicating that joint learning experiences, trust and mutual respect created a ‘sense of consensus’ rather than a joint view on the issues at stake. To avoid disappointment and conflict in later project development, explicit acknowledgment and acceptance of disagreements should be included as a ground rule in future stakeholder engagement processes.

Health in All Policies? The case of policies to promote bicycle use in the Netherlands

To gather insight on how Health in All Policies (HiAP) is applied in practice, we carried out a case study on transport policies intended to stimulate a shift from car use to bicycling. We reviewed 3 years (2010, 2011, and 2012) of national budgets and policy documents in the Netherlands, followed by two focus group sessions and a second round of document analysis. We found to our surprise, given the country’s history of bicycle promotion, that no HiAP approaches for bicycle promotion remain in place in national transport policies. The Netherlands may face serious challenges in the near future for facilitating bicycle use. Inclusion of health goals requires that the health sector work towards acquiring a better understanding of core values in other sector’s policies.

HIA internationaal: drie bijeenkomsten, één boodschap

Samenvatting“The understanding of health arguments by other sectors is a challenge to us and not to them!” (Josep Figueras, Directeur WHO European Observatory on Health Systems and Policies)Health Impact Assessment (HIA) (noot a) is een methode om beleid vanuit andere sectoren te toetsen op – positieve of negatieve – gevolgen voor de gezondheid van (groepen binnen) de bevolking. Het is een belangrijk instrument voor integraal gezondheidsbeleid. Zowel op lokaal als nationaal en EU-niveau wordt HIA al langere tijd toegepast.

Kemm J, Parry J, Palmer S (editors). Health Impact Assessment: concepts, theory, techniques, and applications. Oxford: Oxford University Press, 2004. 432 pp. £34.50. ISBN 0 19 852629 6

In 1999 a small group of people sat together in Gothenburg at a WHO meeting, trying to design a common definition of Health Impact Assessment (HIA). Now, 5 years later, John Kemm, Jayne Parry, and Stephen Palmer describe to us the progress that has been made since then. Thirty-six chapters were required to cover the various approaches to assessing health impact. ‘ HIA is a confused field ’, write the editors, and indeed their aim is to extract order out of the confusion and provide directions for the future. One of these is about how to influence and assist decision-makers. Kemm and Parry point out that we need to ask decision-makers themselves about how HIA can help them. However, considering that …