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This chapter discusses the health impacts of global environmental change. Topics covered include relationship between globalization and global environmental change, impacts of climate change, interaction between weather and air pollution; effects of economic, social, and demographic disruption; and strategies to reduce population health risks from climate change.

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 introductory chapter presents an overview of macro-level influences on health. Topics discussed include birth, life, death, and the environment; historical perspective; basic requirements of a healthy environment; measuring environmental quality, human exposure, and health impact; patterns of illness throughout the world; impact of environmental factors on health; obstacles to and opportunities for resolving environmental health problems; and the role of the environmental health professional.

This chapter explores two different forms of public protest against land developments that were considered by local people to threaten public health. They diverged in terms of their means of struggle and in the different opportunity structures open to them. In the first example, a protest group, known as ‘Rhondda Against Nanty-y-Gwyddon Tip’ or RANT, came to pursue an oppositional course in their struggle to close and make safe a local landfill site. In the second, local residents used the process of a health impact assessment (HIA), through a university-based HIA support unit and the national public health service for Wales, to present evidence on possible risks to public health in an appeal against an application to extend an opencast mine.

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 discusses the health impacts of car reliance. The various health impacts caused by the modern private motor-vehicle-based transport system includes car crash injuries, lung and heart effects of vehicle-related air pollution, disturbance and blood pressure effects of noise, reduced physical activity and associated obesity, and community disruption from major roads. In addition, greenhouse gases, climate change, and other environmental issues are considered. While there is a convincing and growing body of evidence on these effects, further research is required to fully quantify and understand them. Moreover, comprehensive assessments of the health impacts of transport systems and the value of interventions are essential.

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 presents a brief overview of the health consequences of obesity. It summarizes the epidemiological data on obesity and health and their impact from a patient-centred perspective. Only with an understanding of both these issues can the full impact of health consequences be assessed. It shows that obesity is a very costly disease that is seriously under-treated.

This chapter traces the development of health impact assessment (HIA) for ten years up to 2003. Topics covered include early origins of HIA, the development of methods for HIA, the development of the evidence base of HIA, and the development of the HIA community.

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).

This chapter describes the health impact assessment (HIA) programme for Schiphol Airport, Amsterdam, in which impacts have been quantitated using a combination of health impact calculations, analysis of health registries, and epidemiological field studies. A monitoring programme has been established to check that the predictions made for health impacts of noise management measures and airport expansion are correct. The lessons of this programme for future HIA in the context of an EIA are discussed.

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.

Australia is a federation comprised of six states, two territories and a federal government. There is legislation in all of these jurisdictions requiring Environmental Impact Assessment of major developments but no equivalent nationally consistent legislation requiring HIA, and no systematic framework or triggers for undertaking HIA. The purpose of and process for undertaking Health Impact Assessment (HIA) in Australia has been a contested area since the National Health and Medical Research Council released the first National Framework for Environmental and Health Impact Assessment in 1994. There has been concern that there is no evidence of the effectiveness of HIA, dispute over the scope of health issues to be considered and the robustness of evidence. There was also concern that taking a broad view of health might lead to calls for changes in society. Major reviews of HIA have consistently called for Health considerations to be built into EIA but recent studies suggest that while there is some consideration of traditional health risks in air, soil and water there is very limited consideration of a broader view of health and its determinants. While progress in formally adopting HIA has been slow and largely opportunistic consistent progress has been made in building capacity to undertake and provide technical support for HIA.

This chapter reviews literature comparing empirical, theoretical, and normative articles on the relationship between structural adjustment programs (SAPs) and health. The first section discusses the debate, the role-players, their main arguments, and trends in the debate. The second section presents a framework illustrating the causal arguments for how structural adjustment may affect health outcomes and discusses methodological issues in empirical estimations of this relationship. The third section summarizes and analyzes the empirical evidence, and finally draws conclusions from the review.

Meaningful health impact assessment (HIA) depends on the availability of robust quantitative and qualitative evidence of such impacts. This chapter considers what sort of evidence may be required, what may be available, and some of the current gaps. It also reviews what evidence may mean to those conducting and using HIAs.

The third chapter presents the book’s new proposal for addressing the access to medicines problem. It suggests that by collecting and analyzing data on global health, people can come up with new ways to improve poor people’s access to essential drugs and technologies. It suggests utilizing information about medicines’ global health impact (organized by drug, disease, country, and company) to create incentives for positive change. One possibility is to give pharmaceutical companies with the most impactful drugs a Global Health Impact label to use on all their products. Highly rated companies will have an incentive to use the label to get a larger share of the market. Further, socially responsible investment companies could include Global Health Impact companies in their portfolios. Finally, having a Global Health Impact certification system for pharmaceutical companies would open the door to all kinds of fruitful social activism. One possibility is a Global Health Impact licensing campaign. Pharmaceutical companies rely, to a large extent, on university research and development. So, if universities allow only certified companies to benefit from their technology, companies will have an incentive to abide by Global Health Impact standards.

This chapter describes the Wales Health Impact Assessment Support Unit (WHIASU) and the evolution of HIA in the context of Wales as a devolved nation with its particular approach to public health. The character of WHIASU can only properly be understood in terms of its history and the wider social, policy, and political context of which it is a part. WHIASU's emphasis on involving people potentially affected by a proposal in HIA mirrors the emphasis in Welsh policy documents on citizen engagement as a mechanism for policy and service development. This was intended to contrast markedly with individual choice as the driver for change in England as well as resonating with a sociological theory of knowledge that supports the value of deliberative processes that involve lay people in dialogue with professionals.

This chapter focuses on the impact of climate change and stratospheric ozone depletion on health. These changes are the consequence of overload and breakdown of global homeostatic mechanisms. Climate change and ozone depletion demonstrate that the planet is a closed system. Problems like these that are inherently global in nature require a response that is also worldwide. This means that international cooperation will be even more important than in the past, when diseases may have been distributed globally but the causes were essentially local.