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@comcast.net<mailto:mbrenman001@comcast.net>"
<mbrenman001@comcast.net<mailto:mbrenman001@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@chrispy.net<mailto:h+t--friends@chrispy.net>>
Cc: "Martin Birley"
<martin@birleyhia.co.uk<mailto:martin@birleyhia.co.uk>>, "Salim Vohra
(sal@PUBLICHEALTHBYDESIGN.COM<mailto:sal@PUBLICHEALTHBYDESIGN.COM>)"
<sal@PUBLICHEALTHBYDESIGN.COM<mailto:sal@PUBLICHEALTHBYDESIGN.COM>>,
"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@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 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