Ten Years of SOPHIA

In 2021, the Society of Practitioners of Health Impact Assessment (SOPHIA) celebrates its 10-year anniversary. As part of the celebration, we asked founding SOPHIA members and key SOPHIA leaders to reflect on the organization’s formation in 2011, to share their thoughts on SOPHIA’s key challenges and to highlight important accomplishments. Respondents also weighed in on the future of SOPHIA and the value of SOPHIA membership. Research was conducted using written surveys, interviews, and review of written material. Surveys were sent in July of 2021 to eleven active SOPHIA members, many of whom have served as president, vice president, board member or founding member for SOPHIA. Of the eight survey recipients who were interviewed or completed the written survey, nearly all have been conducting Health Impact Assessments (HIAs) for 10 or more years. Survey respondents’ HIA experience included assessments focused on a variety of policies, projects and programs, including housing, land use, economic security, the built environment, transportation, immigration policies, minimum wage policies, criminal justice and more. This article includes information gleaned through written material review; however, it is largely based on the feedback, insights and experiences shared by survey respondents verbally and in writing.

Child-centred pandemic decisions: how the Precautionary Principle can generate better risk assessment in an era of uncertainty

Key messagesRisk assessment for children has been a polarising issue during the Covid-19 pandemic. Governments around the world are preparing to ‘open up’ before risks to children are fully quantified, with unknown implications for their long-term health.Applying the Precautionary Principle to child health requires decision makers to 1) take preventive action until risks are better understood; 2) ensure that the burden of proof rests with proponents of risk; 3) explore alternatives to the risk; and 4) use participatory approaches to decision-making.Policies relating to children must be centred on the rights and wellbeing of children. We provide a framework for comprehensive Health Impact Assessments to ensure that direct and indirect impacts upon children are taken into account in major policy decisions.Elimination strategies offer an integrated approach to the protection of children’s wellbeing, the wellbeing of the population as a whole, and health equity. Where countries are transitioning away from elimination, a tight suppression approach is preferable to loose suppression or mitigation.

Quantifying the Health Benefits of Urban Climate Mitigation Actions: Current State of the Epidemiological Evidence and Application in Health Impact Assessments

While ambitious carbon reduction policies are needed to avoid dangerous levels of climate change, the costs of these policies can be balanced by wide ranging health benefits for local communities. Cities, responsible for ~70% of the world's greenhouse gas (GHG) emissions and home to a growing majority of the world's population, offer enormous opportunities for both climate action and health improvement. We aim to review the current state of knowledge on key pathways leading from carbon mitigation to human health benefits, and to evaluate our current ability to quantify health benefits for cities around the world. For example, because GHGs and air pollutants are both released during fuel combustion, reducing fuel burning can reduce both GHGs and air pollutants, leading to direct health benefits. Air quality improvements may be particularly important for city-scale climate action planning because the benefits occur locally and relatively immediately, compared with the global and long-term (typically, decades to centuries) benefits for the climate system. In addition to improved air quality, actions that promote active transport in cities via improved cycling and pedestrian infrastructure can reap large cardiovascular health benefits via increased physical activity. Exposure to green space has been associated with beneficial health outcomes in a growing number of epidemiological studies and meta-analyses conducted around the world. Finally, noise is an underappreciated environmental risk factor in cities which can be addressed through actions to reduce motor vehicle traffic and other noise sources. All of these environmental health pathways are supported by well-conducted epidemiological studies in multiple locales, providing quantitative exposure–response data that can be used as inputs to health impact assessments (HIAs). However, most epidemiologic evidence derives from studies in high-income countries. It is unclear to what extent such evidence is directly transferable for policies in low- and middle-income countries (LMICs). This gap calls for a future focus on building the evidence based in LMIC cities. Finally, the literature suggests that policies are likely to be most effective when they are developed by multidisciplinary teams that include policy makers, researchers, and representatives from affected communities.

Applying Health in All Policies at the University of Wisconsin-Madison

The University of Wisconsin-Madison’s (UW-Madison) response to the COVID-19 pandemic demonstrates how prioritizing health in campus policies is necessary to achieve better health, educational, and workforce outcomes. COVID-19 cases increased on campus as students attended in-person classes at the beginning of the 2020-21 academic year, though dampened as the university ramped up protective measures. Harm may have been prevented had proactive and analytical approaches to policy making, which are foundational to a Health in All Policies (HiAP) approach, been implemented sooner. Specifically, comprehensive and rapid Health Impact Assessments could enhance university leadership’s ability to mitigate the negative effects of existing and future policies. Here, we recognize the COVID-19 pandemic as a justifiable catalyst for implementing a HiAP approach in UW-Madison policymaking. We recommend that the university establish a HiAP subcommittee within the Division of Diversity, Equity & Educational Achievement. This action standardizes the use of tools essential to HiAP across campus while limiting the demand on existing university committees and other administrative offices.

Health Impact Assessments of Health Sector Proposals: An Audit and Narrative Synthesis

Background: Health impact assessment (HIA) is a tool used to assess the potential health impacts of proposed projects, programs, and policies. The extent of the use of HIAs conducted on health sector proposals, and what they focus on, is currently largely undocumented. This paper reviews HIAs conducted on health sector proposals, their characteristics and describes the settings in which they were conducted. Methods: A systematic review was conducted, including peer-reviewed journals and grey literature utilizing keywords, synonyms, and subject headings relevant to HIA and the health sector. Eligibility criteria were independently applied to the identified works and data appraisal conducted using the Critical Appraisal Skills Programme qualitative checklist tool. Results: 19 HIAs were identified and included in the review, including 13 rapid, three intermediate, and two comprehensive HIAs. The HIAs use was evident across a range of health service contexts, though all but one had been conducted in developed countries. Conclusion: The use of HIAs in the health sector is limited. There were various benefits attributed to the HIAs analysed including and not limited to the allocation of resources, reducing inequalities, and identification of possible negative consequences of a project. There is an opportunity to improve the use and reporting of HIAs across health settings internationally to enhance the consideration of broader determinants of health, influence decision making, and use of evidence in health sector planning for the future.