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This chapter provides an overview and introduction to the now vast data on the adverse health consequences of passive smoking, covering the risks to passive smokers, including the fetus, infants and children, and adults. In about three decades, progression has been made from the first studies on passive smoking and health to definitive evidence that passive smoking causes disease. The evidence derives from not only epidemiological studies, but studies with biomarkers documenting that tobacco smoke inhaled by non-smokers delivers doses of toxic components and metabolites to target organs. There are also animal studies and extensive data on patterns of exposure. The strength of the evidence and its public health implications have been a strong force for motivating tobacco control policy.

This chapter offers a scientific perspective and reviews available evidence on how volunteering affects health and longevity. It focuses on formal volunteer work — performed through a school, hospital, library, or environmental, political, or other organization. Formal volunteer work stands in contrast to more casual or unorganized helping activities, often termed ‘informal helping’, such as giving directions to a stranger or serving as a caregiver for a family member or a neighbour. The chapter's primary focus is on physical health outcomes, although it also cites evidence linking volunteering with improved mental health and subjective well-being. First, it describes the mechanisms by which volunteering might affect physical health, as well as moderating factors that might strengthen or weaken these influences. Next, it reviews empirical evidence suggesting that volunteering may indeed provide physical and mental health benefits. It concludes by discussing some practical implications and needs for further research.

This chapter examines the relationships between economic recessions, unemployment, and health. The chapter is divided into four main sections. The first section examines the effects of economic recessions on health. The second section summarizes the literature on the relationship between unemployment and health. The effects of recessions on health inequalities, as well as the importance of unemployment to health inequalities are then examined. Variation by welfare state in the health effects of recessions, as well as in the relationship between unemployment and health are then examined.

This chapter deals with how to measure and value different degrees of health improvements — in health terms and in monetary terms. Beyond the valuation of improved health per se, the chapter discusses how to value the production gains following people's return to work as a possible consequence of the improved health. Exercises and suggested readings are included at the end of the chapter.

Child work is a continuum, and there is no clear demarcation of when work moves from a positive experience to a harmful one. In spite of the risks posed by many forms of work, for large numbers of children, the alternative to work may be hunger or other adverse outcomes. This chapter describes the health effects of children's work and the impact of this work on the communities in which they live. The chapter is divided into three parts. First, it examines the difficulties in determining the impact of child labour on health. Second, it describes approaches which can help in understanding the impact of child labour. Third, it presents examples of the impact of child labour on the health of children, families, and communities and how these impacts might be more effectively measured.

This chapter examines the health effects of three traditional dimensions of the physical work environment: chemical hazards including exposure to toxic substances used in industrial processes (asbestos, silica, coal dust, and lead); environmental factors such as noise, vibration, and workplace injuries; as well as ergonomic hazards such as repetitive movements, heavy lifting, and including shift work. It argues that despite changes in the nature of the economy in advanced market democracies, these physical hazards are still an important public health issue for many working age people. It suggests that differences in occupational exposures may well be of significance in terms of explaining socio-economic inequalities in health. It also examines how exposure to physical work environment hazards varies by country and how legislation can reduce the levels to which workers are exposed.

The investigation of neighborhood effects on health raises a series of conceptual and methodological issues related to the presence of observations at a lower level (e.g., individuals) nested within observations at a higher level (e.g., neighborhoods). Many of these issues are generalizable to a broad set of common situations in epidemiology involving nested data structures. The presence of multiple levels of organization (or nested sources of variability) requires the development of theories about how factors defined at different levels are related to health outcomes, and identifying the most appropriate research design for the question being investigated based on the level about which inferences are to be made and the level (or levels) at which the constructs relevant to the outcome are defined and measured. This chapter reviews the use of group-level variables in epidemiology; summarizes the characteristics of ecological studies, studies of individuals, and multilevel studies; and discusses some of the conceptual and methodological challenges that multilevel analysis faces, using the example of the investigation of neighborhood effects on health.

This chapter begins by outlining the conceptual motivation behind multilevel analyses and by identifying a core set of research questions that this approach addresses. It then introduces the idea of multilevel structures and discusses simple and complex multilevel models. It emphasizes that the key strength of multilevel models lies in modeling heterogeneity at different levels and shows how multilevel models can be extended to additional contextual levels (e.g., neighborhoods nested within regions). The estimation procedures underlying such models are discussed, showing how a multilevel framework can provide a general, unified approach to data analysis and how this can be achieved by extensions to the basic hierarchical structure of individuals nested within contexts. The chapter concludes with a discussion of issues that researchers should be aware of when applying multilevel methods.

This chapter reviews the current state of affairs on this intersection between the older health inequalities tradition and the evolving health impact assessment (HIA) field. It then summarizes the available evidence on health inequalities. It outlines the next possible approaches for assessing the impact of policies on health inequalities, and a few HIA examples are discussed in which health inequalities have been explicitly considered. Finally, a research agenda is laid out to develop the tools that will in the future help us to assess reliably and validly the impact of policies on health inequalities.

This chapter examines the contributions of several large prospective studies conducted over the second half of the 20th century to our understanding of the health hazards of tobacco use. Beginning in the early 1950s, large cohort studies played a major role in helping to identify the multitude of adverse health effects caused by tobacco use, particularly manufactured cigarettes. They demonstrated that the harmful effects applied to women as well as men, that cigarettes with low machine-measure tar and nicotine were no less hazardous with respect to lung cancer than filter-tip ‘regular’ tar cigarettes, and that the burden of disease caused by smoking increased over time as smokers initiated regular cigarette smoking at progressively earlier ages. Large cohort studies will continue to be important for monitoring the course of the epidemic as it evolves in different cultures and for sustaining the political resolve to end it.

This chapter outlines past and present developments of health impact assessment (HIA) at the policy level in Canada. The examples cover the unsuccessful attempt to institutionalize HIA at cabinet level in British Columbia, the recent experience with HIA as a tool for HPPs in Québec, and the approach to international trade agreements and health at Health Canada.

This chapter presents an introduction to health impact assessment (HIA). Topics discussed include definition and purpose of HIA, the conceptual roots of HIA, positivistic and relativistic bases for predictions in HIA, values of HIA, and quality criteria for HIA. An overview of the subsequent chapters is presented.

This chapter describes the health impacts of the use of nuclear weapons and the challenges of controlling nuclear weapons today. It describes the human health effects of weapons production. It discusses the control of nuclear weapons through international treaties and other means, and the movement to abolish nuclear weapons.

A new generation of neighborhood-level research has emerged in recent years to address the question of why so many health-related outcomes are concentrated ecologically. This chapter highlights the implications of such research for our knowledge about the community-level context of public health and safety. Drawing on recent lessons from sociological research, it identifies what it is about neighborhoods—above and beyond the status and attributes of the individuals who live there—that might lead to various health outcomes.

Health impact assessors who wish to advise policy makers and base their health impact assessment (HIA) on the fullest scientific evidence must understand the potential and pitfalls of epidemiology. This chapter explores how epidemiological reasoning can give insight into the causal mechanisms by which decisions impact on health, goes some way towards estimating the size of those impacts, and thereby provide a basis for prediction.

Canada was one of the first countries in the world to develop a standardized national approach to health impact assessment (HIA). This chapter describes the HIA framework and its evolution over the past decade.

Chapter 6 describes the transformation of Belarusian post-Chernobyl research efforts, from the systematic development of radiological research infrastructures in the last years of the Soviet Union to massive restructuring and reframing of Chernobyl-related research ten years later, as a result of changing political and economic interests of the Belarusian government. Infrastructural disruptions to data collection and analysis created the conditions for research relying on theoretically, rather than empirically, driven approaches, and this bias supports minimizing the scope of Chernobyl-related health effects. The chapter observes that restructuring and reframing of Chernobyl-related research led to the near disappearance of the radiation factor as an object of inquiry, and to the greater invisibility of local experts who would claim expertise in the health effects of radiation exposure due to the Chernobyl accident.

This chapter examines international policies on health impact assessment (HIA). Topics covered include policies of the World Health Organization, the European Community, and other intergovernmental organizations.

This chapter reviews the development of environmental impact assessment (EIA) to set the context against which lessons can be drawn. It briefly considers the rationale for EIA and indicates the extent of its spread across the globe as a legal procedure. The chapter then explains how EIA works. This will encompass a consideration of the procedural nature of EIA, which is a crucial point when it comes to the possibility for legal action. It also considers the role of stakeholders, the potential for conflicts of interest to arise as well as public consultation. Finally, it considers the funding of an EIA, which is a practical point of great significance when considering the impartiality of the assessment. The chapter concludes by drawing on the experience with respect to health impact assessment (HIA).