Mirko Winkler Ecosystem Health Sciences Unit Health Impact Assessment Group

1. Mirko WinklerEcosystem Health Sciences UnitHealth Impact Assessment Group HIA in developing countries: Untapped potential of health impact assessment HIA2013, Geneva, 4. October 2013

2. Achieve universal health coverage • Enhance health gains from sustainable development investments and decisions • Adopt health indicators to measure progress/ achievements in sustainable development Potential! Capacities?

3. Guiding research questions of the paper • What is the potential of HIA for linking health to „green economy“ and sustainable development? • Where are major gaps in HIA capacities? • How can HIA practice be promoted where capacity gaps exist?

4. The potential of HIA • Major drivers of global change • Global burden of disease Global burden of disease Population growth and urbanisation Demand in natural resources Global climate change

5. Major drivers of global change • Global distribution of impacts related to major drivers of global change •  Ranking as part of the presentation World map by quartiles of Human Development Index (HDI) (2013)

6. Major drivers of global change Population growth and urbanisation

7. Major drivers of global change Population growth and urbanisation World Urbanization Prospects, the 2011 Revision:Growth rates of urban agglomerations, 1970-2011

8. Major drivers of global change • Demand in natural resources • Growing population + urbanization + … + … = Increased demand in natural resources • Tropical regions are promising locations for: • mineral and energy extraction; • production of hydro- and solar-power, as well as biofuel; and • food production. The Economist (2012). Resource nationalism in Africa. Rulli et al., PNAS (2013). Global land and water grabbing.

9. Major drivers of global change • Global climate change • Growing population + urbanization + depletion of natural resources + … + … = Global climate change • Global climate change affects the health status of millions of people, particularly those with low adaptive capacity. Patz et al. 2007: Climate Change and Global Health: • Cumulative CO2 emissions 1950-2000 • Distribution of climate-sensitive health effects (malaria, malnutrition, diarrhea, and inland flood-related fatalities)

10. Major drivers of global change • Global distribution of anticipated health impacts •  Rating as part of the presentation • Major drivers of global change will inordinately affect low- and medium-HDI countries

11. Blue = Non-communicable diseases Red = Communicable, maternal, neonatal, and nutritional disorders Green = Injuries Global burden of disease (2010)

12. Global burden of disease (2010) • The burden of disease in low- and medium-HDI countries poses major qualitative and quantitative challenges

13. The potential of HIA • Major drivers of global change will inordinately affect low- and medium-HDI countries • The burden of disease in low- and medium-HDI countries poses major qualitative and quantitative challenges Burden of disease in low- and medium-HDI countries • Adaptation of capacities and services of health systems (e.g. migration) • Adaptation of health-related policies and programmes to changing disease epidemiology (e.g. lifestyle changes) • Minimize risks of environmental health hazards (e.g. natural disasters) Population growth and urbanisation Demand in natural resources Global climate change • HIA is an ideal tool for raising awareness among decision-makers of the link between health and other factors so that they consider health effects in the planning of policies, programmes and projects

14. Health impact assessment The potential of HIA Burden of disease in low- and medium-HDI countries Population growth and urbanisation Demand in natural resources Global climate change Environmental, social, human rights and other impact assessments

15. HIA capacities Current global HIA practice (A) Countries, states and regions that (A) are actively promoting health impact assessment (HIA) through a policy, regulation or other means of endorsement and (B) have produced guidelines on HIA (adapted from Hebert et al., 2012) (B) • Gaps in HIA capacities and policy frameworks are evident

16. Promotion of HIA How can HIA practice be promoted where capacitiy gaps exist? • Cornerstones for the promotion and strengthening of HIA practice in developing countries (Caussy, 2003): • Existing policy frameworks and procedures • Capacity building mechanisms for HIA • Institutional infrastructure • Intersectoral collaboration In most developing countries, particularly in the African Region, these components are still largely inexistent Increased HIA practice HIA community (i.e. practitioners and academics). HIA capacity building Awareness of HIA approach Demand in HIA approach Interest in HIA approach

17. Promotion of HIA • Establishment of a regional competence centre in HIA as a priority for the African Region • Build awareness of, and interest in, HIA as an approach for health promotion • Demand for HIA at the national and regional levels • Policy frameworks (e.g. requirements for HIA) at national level Increased HIA practice HIA community (i.e. practitioners and academics). HIA capacity building Awareness of HIA approach Demand in HIA approach Interest in HIA approach

18. Promotion of HIA • Scrutinize and amplify HIA tools and methods so that they are specifically designed for the given context • Strengthen the evidence-base for the value and practicability of HIA in low- and medium-HDI countries (e.g. WHO website: 7 out of 61 examples of HIA derive from developing countries) • Actively promote partnership with local stakeholders by involving them in the entire HIA process Increased HIA practice HIA community (i.e. practitioners and academics). HIA capacity building Awareness of HIA approach Demand in HIA approach Interest in HIA approach

19. The way forward • Dissemination • WHO’s Western Pacific Regional Office – Thematic working group for HIA • PAHO (Jonathan Drewry) • Initiative on HIA in the extractive industries/(energy and mining sector?) • Initiative around HIA promotion and capacity building in Africa (IAIA14)? • Legislation • Set of examples deriving from different developing regions (e.g. Mongolia, Thailand, Brazil, Africa?) • Capacity building • HIA training with a specific focus on developing country settings and challenges (e.g. online course, training modules) • Include local human resources in the HIA process! (e.g. Mongolia) • Huge joint effort is needed

20. Acknowledgments We thank various colleagues from the WHO Regional Offices and elsewhere for their inputs on national and regional mechanism for the promotion and regulation of HIA Thank YOU for your attention and interest