I haven't read the transport HIA under discussion, but
1 the social and environmental determinants of health are equally
important, bias would be in favoring either.
2 removing cars from cities is important for many health determinants.
3 a recommendation to do so in an HIA should always consider differential
effect. If it did not do so it would be a poor HIA and should be improved.
Best
Martin Birley from phone
On 13 Jun 2014 13:04, "Scott-Samuel, Alex"
<A.Scott-Samuel(a)liverpool.ac.uk>
wrote:
Very interesting Marc. I'm not really qualified to
comment on the San
Francisco HIA because while I understand that San Francisco does have good
public transport – which is crucial if cars are banned from cities – i'm
not clear how genuinely accessible public transport is to all low income
people in the bay area. Also I'm much more red then green!
With regard to caste and class, the UK situation is of course much broader
than income and wealth: we have a long tradition of sociocultural
discrimination and snobbery - and social status and social connections are
crucially important here. Our caste system also includes symbolic elements
like peerages, knighthoods and a Byzantine system of various medals and
other 'honours'. Professions also play their part, such that getting a
medical degree or becoming a religious minister gives you a hike up the
caste system.
Best wishes, Alex
On 13 Jun 2014, at 12:42, "mbrenman001(a)comcast.net<mailtot;mailto:
mbrenman001(a)comcast.net>" <mbrenman001(a)comcast.net<mailtomailto:
mbrenman001(a)comcast.net>> wrote:
Thanks, Alex. Yes, I had a feeling Ben was referring to the situation of
African-Americans in the US. There is a tendency here in the US also to
reduce civil rights discussions to an African-American context. One
fascinating difference between US and UK discrimination issues involves the
presence of caste issues in the UK. In the US, we hate to discuss social
class. In the courses I teach on human rights in graduate school, I can
get the students to discuss race much more readily than I can class.
Almost everybody, especially our politicians, refers to everyone as middle
class. The 1% and Occupy movements don't even like to talk about the upper
class, but rather differentiate by income and wealth. How does this
resonate with HIA? I criticized an HIA done in San Francisco last year or
the year before, because it advocated a car cordon scheme in San Francisco,
as has been done in a couple of European and UK cites, to keep cars out of
downtown. Like other road tolling schemes, this one would have had
regressive economic effects on low income people (by charging large amounts
of money to bring a car into the City). But because the bias of the HIA
was toward car hating environmentalism, and was based on
data/instructions/assumptions provided by institutional car
haters/environmentalists, it ignored the idea that historically for some
people, cars represent social and physical mobility, and that low income
and working class people have far less discretionary income than middle and
upper class people. The class analysis escaped the folks who did the HIA,
who are otherwise nice and thoughtful people doing excellent work.
Marc
________________________________
From: "Alex Scott-Samuel" <A.Scott-Samuel(a)liverpool.ac.uk<mailtomailto:
A.Scott-Samuel(a)liverpool.ac.uk>>
To: "marcomcast"
<mbrenman001@comcast.net<mailto:mbrenman001@comcast.net>>
Cc: "Jenny Mindell"
<j.mindell@ucl.ac.uk<mailto:j.mindell@ucl.ac.uk>>,
"TRB Health and Transportation" <h+t--friends(a)chrispy.net<mailtomailto:
h+t--friends(a)chrispy.net>>t;>, martin(a)birleyhia.co.uk<mailtolto:
martin(a)birleyhia.co.uk>gt;, "Salim Vohra (sal(a)PUBLICHEALTHBYDESIGN.COM
<mailto:sal@PUBLICHEALTHBYDESIGN.COM>)" <sal(a)PUBLICHEALTHBYDESIGN.COM
<mailto:sal@PUBLICHEALTHBYDESIGN.COM>>, "Ben Harris-Roxas (
b.harris-roxas@unsw.edu.au<mailto:b.harris-roxas@unsw.edu.au>)" <
b.harris-roxas@unsw.edu.au<mailto:b.harris-roxas@unsw.edu.au>>, "Ben
Cave" <ben.cave@bcahealth.co.uk<mailto:ben.cave@bcahealth.co.uk>>
Sent: Friday, June 13, 2014 4:26:45 AM
Subject: Re: [H+T--Friends] H+T--Friends Digest, Vol 38, Issue 4 - HIA
I think your comments are spot on Marc. My view is that most of us who
practice HIA in the 'economic north' do so from within the confines of a
well protected establishment which while it occasionally gives tokenistic
acknowledgement to the issues you describe, continues primarily to focus
inwards on promoting, protecting and sustaining itself. I imagine Ben from
Australia was referring to the fact that American civil rights have been
chiefly developed by the black former slavery population rather than first
nation Americans. While this is indeed the case it does not, as you point
out, change the situation whereby the massive scale of racism in both
countries (and also of course in the UK) means that civil rights and for
that matter HIA are crucially important.
This correspondence has been a welcome reminder of the silos in which we
all work and I do hope that it will lead to stronger links with groups
representing the dispossessed who need us most.
Best wishes, Alex
On 13 Jun 2014, at 11:56, "mbrenman001(a)comcast.net<mailtot;mailto:
mbrenman001(a)comcast.net>" <mbrenman001(a)comcast.net<mailtomailto:
mbrenman001(a)comcast.net>> wrote:
Thanks very much, Jenny and colleagues, these thoughts are fascinating and
helpful. I appreciate the time and energy everyone has taken to participate
in this discussion.
I am troubled by this comment from Australia: "civil rights as they're
construed in the United States have very little relevance in other
settings." In reality, Australia has a robust civil rights legal regime
and enforcement system, very similar to (and dare I say, in large part
derived from) the US system, with the Australian Human Rights Commission
analogous to the US Equal Employment Opportunity Commission. When I search
the site of the AHRC, I find no reference to HIA. So it sounds like the
HIA folks and the civil rights/human rights folks in Australia need to be
talking to one another. But beyond that, while not claiming to be an
expert on civil rights in Australia, it is clearly wrong to say that "civil
rights as they're construed in the United States have very little relevance
in other settings." In fact, Australia and the US both have very serious
issues with historical maltreatment of indigenous populations; both have
disability access and gender/womens issues that are almost identical; both
have illegal and legal immigration issues involving people of different
races and national origins from the dominant population, including issues
of incarceration of undocumented people; and both have changing
demographics, with a growing Asian population in Australia, and a growing
Latino population in the US. One area of really big difference is gun
control, an epidemic public health problem in the US, and under much more
control in Australia. Even President Obama very recently referred to
Australia's progress in that area.
Best regards,
Marc
________________________________
From: "Jenny Mindell"
<j.mindell@ucl.ac.uk<mailto:j.mindell@ucl.ac.uk>>
To: "marcomcast"
<mbrenman001@comcast.net<mailto:mbrenman001@comcast.net>>,
"TRB Health and Transportation" <h+t--friends(a)chrispy.net<mailtomailto:
h+t--friends(a)chrispy.net>>
Cc: "Martin Birley"
<martin@birleyhia.co.uk<mailto:martin@birleyhia.co.uk>>,
"Salim Vohra (sal(a)PUBLICHEALTHBYDESIGN.COM<mailtolto:
sal(a)PUBLICHEALTHBYDESIGN.COM>)" <sal(a)PUBLICHEALTHBYDESIGN.COM<mailtomailto:
sal(a)PUBLICHEALTHBYDESIGN.COM>>t;>, "Alex Scott-Samuel (
A.Scott-Samuel@liverpool.ac.uk<mailto:A.Scott-Samuel@liverpool.ac.uk>)" <
A.Scott-Samuel@liverpool.ac.uk<mailto:A.Scott-Samuel@liverpool.ac.uk>>,
"Ben Harris-Roxas (b.harris-roxas(a)unsw.edu.au<mailtolto:
b.harris-roxas(a)unsw.edu.au>)" <b.harris-roxas(a)unsw.edu.au<mailtomailto:
b.harris-roxas(a)unsw.edu.au>>t;>, "Ben Cave"
<ben.cave(a)bcahealth.co.uk<mailtomailto:
ben.cave(a)bcahealth.co.uk>>
Sent: Friday, June 13, 2014 2:29:22 AM
Subject: RE: [H+T--Friends] H+T--Friends Digest, Vol 38, Issue 4 - HIA
I forwarded this email chain to colleagues who are more active than I am
currently in HIA in the UK and elsewhere.
Here are their responses:
Martin Birley:
1. all aspects of HIA need improvement
2. ideally there would be a team with a wide range of expertise, in
practice one person often has to cover everything
3. there should be a policy /legislation review and I will take away the
need to check that equality legislation is always included.
4. most of my work is ESHIA so I interact with a social assessment team
who would be the lead for this aspect
5. equality minority issues are always in my mind but then so are very
many other issues
6. I do not favour the fragmentation of HIA into sub fields but equality
HIA has received much attentiont in some jurisdictions.
7. international HIA is usually in multiple languages. In the UK we have
used Bangladeshi speakers for community surveys, in Tower Hamlets.
8. I've never had to be an expert witness.
Ben Harris-Roxas (Australia):
I agree with everything Martin's said and just add that civil rights as
they're construed in the United States have very little relevance in other
settings. Human rights, etc is more relevant and there's been quite a lot
of thinking done on that, if not much practice.
Salim Vohra:
This is a very interesting issue that Marc raises.
"Health impact assessment (HIA) has emerged in the U.S. as a promising way
to increase social and environmental justice by addressing health equity
within transportation planning."
I have always felt the aspirations put on HIA have always been bigger than
what it can sensibly achieve.
I don't see HIA as a way of tackling social and environmental justice, it
may help provide evidence but on its own its a weak approach because of the
context within which it is undertaken and the limitations imposed by the
key parties (see next paragraph). It does address health equity but in a
narrow sense. It does not often get a say in why a development is located
in the place that it is and not another i.e. a poor deprived area compared
to a more prosperous one. These are often the default contexts that we have
to assume.
I think civil and human rights opens up issues at project level that a)
need a broader policy analysis approach e.g. integrated assessment and
strategic policy assessment and b) needs political/governmental backing to
address or a very sympathetic business or NGO willing to explore their own
inadequacies and what it would take to remediate them. This is rare.
As a part-time epidemiologist I would say that it’s great that most
epidemiologist don't get up and say that X exposure is definitively causing
Y in Z minority groups.
Fintan Hurley at the IOM, talks about balance of probabilities rather than
certain evidence (similar to Marc's analogy of the lower buden of proof in
different parts of justice systems) as how HIA works and we do in HIA try
and say who is likely to be affected the most/most sensitive to impacts.
Alex Scott-Samuel:
My view is that social and environmental justice and human rights are
entirely appropriate dimensions with which HIA should engage. As Martin
points out, variants on 'health equity impact assessment' have been around
for quite a while – and Ben HR of course worked on the original equity
focused HIA project. The prominence given to HIA in the Commission on
Social Determinants of Health and Marmot reports will hopefully over time
increase the engagement of HIA with social equity.
Environmental justice is much more prominent in the US thanks to the very
vocal civil rights community. That is no excuse for its inadequate
development here: hopefully in the future we will get more HIA folk who are
prepared to advocate for those who get dumped with the worst environments
and the greatest environmental insults.
As regards human rights, there has as Ben H-R says been a fair bit of
thinking about this but not enough action.
The references below outline the potential for HIA in the context of human
rights and of social equity at the global level
O’Keefe E, Scott-Samuel A. Health impact assessment and globalization. In:
Kawachi I, Wamala S, eds. Globalization and Health. Oxford: Oxford
University Press, 2006, 201-216
• Scott-Samuel A, O’Keefe E. Health impact assessment, human
rights and global public policy: a critical appraisal. Bulletin of the
World Health Organization, 2007, 85, 212-17
• O’Keefe E, Scott-Samuel A. Health impact assessment as an
accountability mechanism for the International Monetary Fund: the case of
Sub-Saharan Africa.International Journal of Health Services,2010, 40(2),
339-345
Ben Cave:
I agree with the tenor of what has been said by my UK & Oz colleagues and
also with the points made by Nicole Iroz Elardo in the separate email
thread.
This is a welcome and important question – “(HIAs) rarely contain legal
concepts at all”.
HIAs do, try to do, and are expected to do many things. Too many things, I
think.
The answers in this email thread illustrate what a small set of academics
and practitioners understand it to do: from analysis of potential effects
of projects to national and supranational policies/goals.
Ben HR’s typology (2010) - to me more of a spectrum - can help understand
this.
We are all working on different aspects of HIA and share a desire to see
health addressed fully and inequalities reduced. As Martin says every
aspect of HIA needs to improve – agreed - but so does every aspect of
pretty much everything else. So, while we must not be complacent we must
not beat ourselves up.
In the field of spatial planning I am always troubled by the failure of
public health to attract the attention of the lawyers – when it comes to
the crunch point of inquiry our analysis is too easily dismissed. For some
time we have made the policy argument that health & wellbeing are
important. It gets much harder when we try to see ways in which PH can help
planners to support decisions on individual applications. Health protection
has long been a tightly regulated field. We are struggling to find ways to
enforce the social determinants of health in the courts (leaving aside the
question of whether this is desirable).
I think this will change. Experience is growing in one small field and
this will begin to set precedents. In England there are an increasing
number of planning authorities who are working with PH teams to address
issues on the high street that exacerbate ill health and inequality eg
proliferation hot food takeways, betting shops, payday loan shops etc. This
is Health In All Policies at a very local level. We know these things are
mostly bad for health but how can we construct an argument that 1 more
takeaway, betting shop etc will affect the health of a particular
population. We enter into a complex mix of local economy, political
leadership, planning law, competition law, commercial viability etc.
Everything is open to challenge at inquiry so it becomes very important to
be aware of the legal implications of our advice. I think that public
health advice and analysis can play an important role in supporting the
planners when making individual decisions and in helping them defend those
decisions but it will often be a supporting role. The action of PH teams is
important eg showing they are proactively identifying needs and also that
they are taking action to address needs – a hot food takeaway successfully
challenged a decision to refuse permission. The inspector noted the
importance of health and of combatting obesity but also that there was no
policy to support this. The inference was that the planning authority was
using the obesity argument to stop this development but doing little else
to address obesity.
The same observation applies to Environmental Assessment and HIAs. HIAs
are rarely tested at inquiry. Health is dealt with easily. In Europe we
have failed to establish the way in which health should be addressed in
Strategic Environmental Assessment. If the SEA is faulty the so is the
plan/programme. As with NEPA, the SEA Directive requires human health to be
addressed. This is applied to all plans and programmes that set the
framework for planning consent so is a HUGE opportunity for health to get
involved ‘upstream’. These documents are constituent parts of plans and
programmes. Public health has been silent on this matter, across Europe,
and so the assessment is routinely done by environmental scientists with
ref to air, water etc. The EIA Directive is now set to change. This applies
to projects. Human health will become a core topic. We need to define how
this should be addressed.
So to pick up on Nicole Iroz Erado’s point – an HIA might identify
potential effects on a particular community – the question then becomes can
we frame the (shared) analysis so that our recommendations are robust and
defensible at inquiry? Can we elevate our analysis above an eloquent
articulation of a particular situation? Do not get me wrong – eloquent
articulations are important and contribute to longer term goals but the aim
has to be ensure that effects are addressed in that situation there and
then. At the moment I agree with Marc Brenman’s observation that examples
where we do this are rare. This criticism applies as much, if not more, to
public health as it does to HIA.
Marc & Nicole, and Oz & UK colleagues, I’d be happy to continue
talking/sharing thinking on this so please do not hesitate to get in touch
PS here are refs to 2 recent reports where we have advised planning &
public health teams on the particular question of betting shops, pay day
loan shops etc.
1. R. Pyper and B. Cave. Health evidence base for emerging policy
concerning retail provision. Ben Cave Associates Ltd for NHS Haringey.
2012.
http://bit.ly/SZTxTB
2. R. Pyper and B. Cave. Betting, borrowing and health: health
impacts of betting shops and payday loan shops in Southwark. Ben Cave
Associates Ltd for LB Southwark. Appendix 9, 2014.
http://bit.ly/1s1Rgat
From: mbrenman001(a)comcast.net [mailto:mbrenman001@comcast.net]
Sent: 10 June 2014 19:09
To: TRB Health and Transportation
Cc: Mindell, Jenny
Subject: Re: [H+T--Friends] H+T--Friends Digest, Vol 38, Issue 4 - HIA
Here's what I said: "HIA's rarely address Title VI of the Civil Rights
Act of 1964 or the environmental justice executive order. They rarely
contain legal concepts at all. HIA's are usually conducted by public health
people, who have no background in social equity or civil rights. They often
perform with an environmentalist bias...much HIA work is conducted solely
in English, and the limited English proficiency needs of various
demographic groups are not addressed." My comments were focused on the US,
where the webinar under discussion is occurring. But prove me wrong in the
UK. Quote some HIAs in the UK that discuss the Equality Act (which is
under fire in the UK by the Conservative Party) or the equivalent, and
environmental justice, and use the languages preferred by demographic
groups. This is more than "awareness," since awareness doesn't cure much
of anything. I'll be happy to be proved wrong and would love to use those
good HIA examples.
In recent work with The City Project in Los Angeles, as funded by the
California Endowment, we observed that even those public health
organizations and medical professionals who work with minority health
disparities rarely engage civil rights law to help solve the challenges.
Various professions just seem stuck in their silos. And don't get me
started on trying to use epidemiologists as witnesses in environmental just
cases. I've never found one who would testify that X environmental insult
caused Y adverse effect on a given minority or low income community. They
insist upon a scientific standard of proof, which is way higher than the
administrative civil rights standard of proof of a preponderance of the
evidence.
Marc Brenman
mbrenman001(a)comcast.net
________________________________
From: "Jenny Mindell" <j.mindell(a)ucl.ac.uk>
To: h+t--friends(a)chrispy.net
Sent: Tuesday, June 10, 2014 1:58:44 AM
Subject: Re: [H+T--Friends] H+T--Friends Digest, Vol 38, Issue 4 - HIA
We may like the concept of evidence-based decision-making but being
realistic, political (including planning) decisions are based on a whole
range of things.
So most people now aim for 'evidence-informed decision-making', for which
HIA is well-suited.
It would be daft to think that planners (or others in local, regional or
national government) consider only health when making their decisions.
But the more that the decision-makers are involved with the HIA process,
the more likely they are to engage with the recommendations produced.
And I am very surprised by the statement that public health professionals
are unaware of social equity or civil rights. Certainly not the case in
the UK. And HIA, as accepted across Europe and I thought worldwide,
considers both the health impacts and their distribution across the
population.
Dr Jennifer Mindell
Clinical senior lecturer
Health and Social Surveys Research Group
Research Department of Epidemiology and Public Health
UCL
1-19 Torrington Place
London WC1E 6BT
Tel. 020 7679 1269 (Internal x41269)
Survey doctor: 07770-537238
Fax 020 7813 0242
Email: j.mindell(a)ucl.ac.uk
Web: IRIS web page
Journal of Transport and Health:
www.elsevier.com/locate/jth<
http://www.elsevier.com/locate/jth>
----------------------------------------------------------------------
Message: 1
Date: Sat, 7 Jun 2014 12:29:58 +0000 (UTC)
From: mbrenman001(a)comcast.net
Subject: Re: [H+T--Friends] webinar on Health Impact Assessment (HIA)
in Transportation Planning
To: TRB Health and Transportation <h+t--friends(a)chrispy.net>
Message-ID:
<648017716.8220462.1402144198106.JavaMail.root(a)comcast.net>
Content-Type: text/plain; charset="utf-8"
Who is putting on this webinar? It appears to be something called IBPI.
"The Initiative for Bicycle and Pedestrian Innovation is an exciting center
for research and learning that is focused on bicycle and pedestrian travel.
IBPI?s aim is to advance bicycling and walking as integral elements of the
transportation system in Oregon?s communities." Where's the neutrality and
objectivity?
In regard to this statement, "Health impact assessment (HIA) has emerged
in the U.S. as a promising way to increase social and environmental justice
by addressing health equity within transportation planning," much HIA work
does not adequately address social equity and EJ issues. For example, HIA's
rarely address Title VI of the Civil Rights Act of 1964 or the
environmental justice executive order. They rarely contain legal concepts
at all. HIA's are usually conducted by public health people, who have no
background in social equity or civil rights. They often perform with an
environmentalist bias (see "bicycle innovation" above), which often is in
tension with the needs of low income communities and communities of color.
As to this, "It also augments community and stakeholder engagement by
providing a forum - usually through an advisory committee - where
stakeholders can identify and deliberate about health interests related to
the target plan. While HIA advisory committees are diverse by design," much
HIA work is conducted solely in English, and the limited English
proficiency needs of various demographic groups are not addressed. Another
concern with "advisory committees" is that fact that they only provide
"advice" which the "planning" entity is not obligated to pay any
attention
to. A colleague who leads an immigration advocacy group told me a couple of
years ago, "I no longer serve on advisory committees because they don't
make policy or control anything."
Marc Brenman
mbrenman001(a)comcast.net