Mirko Winkler Ecosystem Health Sciences Unit Health Impact Assessment Group

HIA2013, Geneva, 4. October 2013

HIA in developing countries:

Untapped potential of health impact assessment

Mirko WinklerEcosystem Health Sciences UnitHealth Impact Assessment Group

HIA2013: Untapped potential of HIA04.10.2013 2

Potential!Capacities?

• Achieve universal health coverage• Enhance health gains from sustainable

development investments and decisions• Adopt health indicators to measure progress/

achievements in sustainable development

http://www.who.int/hia/green_economy/en/index.html

HIA2013: Untapped potential of HIA04.10.2013

Guiding research questions of the paper1. What is the potential of HIA for linking health to „green

economy“ and sustainable development?2. Where are major gaps in HIA capacities?3. How can HIA practice be promoted where capacity gaps

exist?

3


The potential of HIA• Major drivers of global change• Global burden of disease

Glob

al b

urde

n of

dis

ease

Population growthand urbanisation

Demand innatural resources

Globalclimate change


Major drivers of global changeGlobal distribution of impacts related to major drivers of global change Ranking as part of the presentation

Score Impact

1 Lowest

2 Medium

3 High

4 Very high

World map by quartiles of Human Development Index (HDI) (2013)


Major drivers of global changePopulation growth andurbanisation

Score Total

1 1

3 3

2 2

4 4


Major drivers of global changePopulation growth andurbanisation

7

World Urbanization Prospects, the 2011 Revision:Growth rates of urban agglomerations, 1970-2011

Score Total

1 2

2 5

4 6

3 7


Major drivers of global change

8

Score Total

1 3

2 7

3 9

4 11

Demand in natural resources • Growing population + urbanization + … + … = Increased demand

in natural resources• Tropical regions are promising

locations for:• mineral and energy extraction;• production of hydro- and solar-power,

as well as biofuel; and• food production.

Rulli et al., PNAS (2013). Global land and water grabbing.

The Economist (2012). Resource nationalism in Africa.


Major drivers of global change

9

Score Total

1 4

2 9

3 12

4 15

Global climate change • Growing population + urbanization + depletion of natural

resources + … + … = Global climate change• Global climate change affects the health status of millions of

people, particularly those with low adaptive capacity. Patz et al. 2007: Climate Change and Global Health:

Cumulative CO2 emissions 1950-2000 Distribution of climate-sensitive health effects (malaria, malnutrition, diarrhea, and inland flood-related fatalities)


Major drivers of global changeGlobal distribution of anticipated health impacts Rating as part of the presentation

Total

49

1215

Major drivers of global change will inordinately affect low- and medium-HDI countries


Global burden of disease (2010)

11

Blue = Non-communicable diseasesRed = Communicable, maternal, neonatal, and nutritional disordersGreen = Injuries


Global burden of disease (2010)

12

The burden of disease in low- and medium-HDI countries poses major qualitative and quantitative challenges


The potential of HIAMajor drivers of global change will inordinately affect low-

and medium-HDI countriesThe burden of disease in low- and medium-HDI countries

poses major qualitative and quantitative challenges

HIA is an ideal tool for raising awareness among decision-makers of the link between health and other factors so that they consider health effects in the planning of policies, programmes and projects

Burd

en o

f dise

ase

in lo

w- a

nd

med

ium

-HDI

coun

trie

s




• Adaptation of capacities and services of health systems (e.g. migration)

• Adaptation of health-related policies and programmes to changing disease epidemiology (e.g. lifestyle changes)

• Minimize risks of environmental health hazards (e.g. natural disasters)


Burd

en o

f dise

ase

in lo

w- a

nd

med

ium

-HDI

coun

trie

s

Environmental, social, human rights and other impact assessments

The potential of HIA

14

Health impact assessment





HIA capacitiesCurrent global HIA practiceCountries, states and regions that (A) are actively promoting health impact assessment (HIA) through a policy, regulation or other means of endorsement

(A)

(B)

Total

4

9

12

15

Gaps in HIA capacities and policy frameworks are evident

and (B) have produced guidelines on HIA (adapted from Hebert et al., 2012)


Promotion of HIAHow can HIA practice be promoted where capacitiy gaps exist?• Cornerstones for the promotion and strengthening of HIA

practice in developing countries (Caussy, 2003):• Existing policy frameworks and procedures• Capacity building mechanisms for HIA• Institutional infrastructure• Intersectoral collaboration

In most developing countries, particularly in the African Region, these components are still largely inexistent

Increased HIA practice

HIA capacity building

Interest in HIA approach

Demand in HIA approach

Awareness of HIA approach

HIA community(i.e. practitioners and academics).


Promotion of HIA







• Establishment of a regional competence centre in HIA as a priority for the African Region

• Build awareness of, and interest in, HIA as an approach for health promotion

Demand for HIA at the national and regional levels Policy frameworks (e.g. requirements for HIA) at national level


Promotion of HIA







• Scrutinize and amplify HIA tools and methods so that they are specifically designed for the given context

• Strengthen the evidence-base for the value and practicability of HIA in low- and medium-HDI countries (e.g. WHO website: 7 out of 61 examples of HIA derive from developing countries)

• Actively promote partnership with local stakeholders by involving them in the entire HIA process


The way forward• Dissemination

• WHO’s Western Pacific Regional Office – Thematic working group for HIA• PAHO (Jonathan Drewry)• Initiative on HIA in the extractive industries/(energy and mining sector?)• Initiative around HIA promotion and capacity building in Africa (IAIA14)?

• Legislation• Set of examples deriving from different developing regions (e.g. Mongolia,

Thailand, Brazil, Africa?)• Capacity building

• HIA training with a specific focus on developing country settings and challenges (e.g. online course, training modules)

• Include local human resources in the HIA process! (e.g. Mongolia)

Huge joint effort is needed


Acknowledgments

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Thank YOU for your attention and interest

We thank various colleagues from the WHO Regional Offices and elsewhere for their inputs on national and regional mechanism for the promotion and regulation of HIA

Mirko Winkler Ecosystem Health Sciences Unit Health Impact Assessment Group

Documents

global health

untapped potential of

global land

major gaps

biofuel productions

health status of millions

distribution of climate

hia capacities