Developing policies for a health environment

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Abstract
The health of a population is largely determined by factors outside the jurisdiction of health ministries and health services. Although it is widely recognised that policies in ‘non-health’ areas need to take health into account, it is unclear how this should best be achieved. The analogous problem, of taking environmental criteria into account in general policy implementation, is addressed by preparing an Environmental Impact Statement (EIS) on projects such as the building of a new power station or a motorway. This is a legal requirement in most countries, at least for major projects. Although health is mentioned in most of the legislation, in practice health impacts are rarely systematically included. It is suggested that, in future, EISs should include health impacts, and that in other situations where an EIS is not appropriate, an analogous process should be carried out to examine health effects. This would be more appropriate if carried out at a higher level than specific projects, and at an earlier stage, in the formulation of policies, programmes or plans. Quantitative health risk assessment is a necessary part of the process. The starting point should be a list of possible options for addressing an identified health need: a multidisciplinary statement should be prepared, that includes economic and social impacts, ecological analysis, and issues of public information and consultation, as well as technical and scientific issues.

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