Dear all

I add my voice to the chorus of support – this has been an interesting dialogue.

However … we have deviated from the original challenge that Marc posed, namely the perceived failure of HIA to invoke/use legal definitions. [I have not revisited the original question – probably a mistake – but I think that sums it up].

This is a valid challenge and one to which we HIA practitioners should respond. It is a challenge for Public Health generally.

From my own point of view I think we should use all levers we can to ensure that the recommendations made are irrefutable and are enacted. Invoking a legal duty, where one exists, would seem to be a powerful way of doing this. This applies as much to HIAs as to other engagements with policy (at any level).

Our conversation has ranged from human rights to the legal arguments in planning decisions (my input) to the loan requirements levied by banks for large infrastructure projects.

The final section on humanitarian aid in Haiti is interesting and sadly not surprising (diarrhoeal disease, sanitation and water supply are not fashionable topics that enjoy a high media profile) but as Martin identifies it is not ‘on topic’. In the Haitian example an authoritative statement on the necessity of enforcing building codes would have saved lives. HIA was not needed here.

My decidedly lay understanding is that legal challenge is all about applying the law to a specific case under scrutiny. How can Public Health help with this? A specific instance might be taken to represent the whole but legal challenge is on that specific instance.

There are examples of public health analysis directly being used to formulate policy and to set legal precedent (not the same thing I know) in Health in All Policies with regard to tobacco, alcohol, sugar etc – it is clear that large amounts of political capital are also needed to ensure the law is continuously enforced.

In analysis and recommendations in HIA it is easier to focus on health protecting aspects eg air quality and noise than on soc dets. In the transport example Marc cited (placing a levy on cars entering centre of city [San Francisco]) it would be simpler to get air quality readings for a defined area and show they exceed or meet thresholds. The population is relatively easy to define. The thresholds are clear and sanctions simple to apply. The low-income group suffer – they will be geographically dispersed – the effects will be harder to show and more open to challenge. Solutions to mitigate adverse effects will be complicated and politically challenging.

What happens at a local level on an individual case? I have yet to find a way in which public health can provide the definitive voice on individual cases at local level concerning social determinants of health. We offer broader supporting evidence. We are better at policy level where larger numbers of people are affected. Does this mean we are of less use in individual cases? We can make a strong case if public health colleagues have the time and resources to gather quantitative & qualitative information about people living in a particular area and the likely effects that a change (transport policy, opening of betting shop etc) would have. Would this be enough to set precedent in other cases or would it be too specific? It would be expensive to do each time a legal challenge was mounted

I end with questions – and I welcome all responses. I’d be interested in some overarching/reflective comments from Marc given that he is the instigator of our interaction.

I gave a talk to PH colleagues a while back where I touched on this – please get in touch if you would like copy of text

Ben