Menzies Centre for Health Policy, Sydney, NSW, Australia.
School of Public Health, and Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
Int J Health Policy Manag. 2018 Feb 1;7(2):144-153. doi: 10.15171/ijhpm.2017.55.
Transport policy and practice impacts health. Environmental Impact Assessments (EIAs) are regulated public policy mechanisms that can be used to consider the health impacts of major transport projects before they are approved. The way health is considered in these environmental assessments (EAs) is not well known. This research asked: How and to what extent was human health considered in EAs of four major transport projects in Australia.
We developed a comprehensive coding framework to analyse the Environmental Impact Statements (EISs) of four transport infrastructure projects: three road and one light rail. The coding framework was designed to capture how health was directly and indirectly included.
We found that health was partially considered in all four EISs. In the three New South Wales (NSW) projects, but not the one South Australian project, this was influenced by the requirements issued to proponents by the government which directed the content of the EIS. Health was assessed using human health risk assessment (HHRA). We found this to be narrow in focus and revealed a need for a broader social determinants of health approach, using multiple methods. The road assessments emphasised air quality and noise risks, concluding these were minimal or predicted to improve. The South Australian project was the only road project not to include health data explicitly. The light rail EIS considered the health benefits of the project whereas the others focused on risk. Only one project considered mental health, although in less detail than air quality or noise.
Our findings suggest EIAs lag behind the known evidence linking transport infrastructure to health. If health is to be comprehensively included, a more complete model of health is required, as well as a shift away from health risk assessment as the main method used. This needs to be mandatory for all significant developments. We also found that considering health only at the EIA stage may be a significant limitation, and there is a need for health issues to be considered when earlier, fundamental decisions about the project are being made.
交通政策和实践会影响健康。环境影响评估（EIA）是一种受监管的公共政策机制，可用于在重大交通项目获得批准之前，考虑其对健康的影响。这些环境评估（EA）中考虑健康的方式并不为人所知。本研究提出了以下问题：在澳大利亚四个主要交通项目的 EIA 中，健康是如何被考虑的，以及考虑的程度如何。
我们开发了一个综合的编码框架，以分析四个交通基础设施项目的环境影响声明（EIS）：三个道路项目和一个轻轨项目。该编码框架旨在捕捉健康是如何被直接和间接地纳入其中的。
我们发现，在所有四个 EIS 中，健康都被部分考虑到了。在新南威尔士州（NSW）的三个项目中，但南澳大利亚州的一个项目没有，这是受到政府向提案者发布的要求的影响，这些要求指导了 EIS 的内容。健康是通过人类健康风险评估（HHRA）进行评估的。我们发现，这种方法的重点过于狭窄，需要采用更广泛的健康社会决定因素方法，使用多种方法。道路评估强调了空气质量和噪声风险，结论是这些风险很小，或者预计会有所改善。南澳大利亚州的项目是唯一一个没有明确纳入健康数据的道路项目。轻轨 EIS 考虑了项目的健康效益，而其他项目则侧重于风险。只有一个项目考虑了心理健康，尽管不如空气质量或噪声详细。
我们的研究结果表明，EIA 落后于已知的将交通基础设施与健康联系起来的证据。如果要全面纳入健康因素，就需要一个更完整的健康模型，以及从健康风险评估转变为主要方法。这需要对所有重大发展都强制执行。我们还发现，仅在 EIA 阶段考虑健康可能是一个重大限制，需要在项目的早期基本决策中考虑健康问题。
