heimaapp超級籤商務價格透明化🅰️電報加ios3652.wlr

Many factors combine together to affect the health of individuals and communities. Whether people are healthy or notis determined by their circumstances and environment. To a large extentfactors such as where we livethe state of our environmentgeneticsour income and education leveland our relationships with friends and family all have considerable impacts on healthwhereas the more commonly considered factors such as access and use of health care services often have less of an impact.

What are the determinants of health?

The determinants of health include:

the social and economic environment,
the physical environmentand
the person’s individual characteristics and behaviours.

The context of people’s lives determine their healthand so blaming individuals for having poor health or crediting them for good health is inappropriate. Individuals are unlikely to be able to directly control many of the determinants of health. These determinants—or things that make people healthy or not—include the above factorsand many others:

Income and social status - higher income and social status are linked to better health. The greater the gap between the richest and poorest peoplethe greater the differences in health.
Education – low education levels are linked with poor healthmore stress and lower self-confidence.
Physical environment – safe water and clean airhealthy workplacessafe housescommunities and roads all contribute to good health. Employment and working conditions – people in employment are healthierparticularly those who have more control over their working conditions
Social support networks – greater support from familiesfriends and communities is linked to better health. Culture - customs and traditionsand the beliefs of the family and community all affect health.
Genetics - inheritance plays a part in determining lifespanhealthiness and the likelihood of developing certain illnesses. Personal behaviour and coping skills – balanced eatingkeeping activesmokingdrinkingand how we deal with life’s stresses and challenges all affect health.
Health services - access and use of services that prevent and treat disease influences health
Gender - Men and women suffer from different types of diseases at different ages.

How does evidence-based approach work within health impact assessment?

An evidence base about the impact that projectsprogrammes and policies have had on health is required to carry out health impact assessment (HIA). The best available evidence is used within the appraisal stage of HIA to determine what impacts may occur (both positive and negative)the size of the impact (if possible) and the distribution of that impact in different population groups. It is generally assumed that the evidence for health impacts existsand that searching and collating will provide the necessary evidence. Unfortunately this is not often the caseand the evidence of health impacts is often not available. This is because of the long causal pathway between the implementation of a project/programme/policy and any potential impact on population healthand the many confounding factors that make the determination of a link difficult. Within the HIA it is important therefore to be explicit about sources of evidence and to identify missing or incomplete information.

Providing a comprehensive review of the evidence base is not simple. It needs to draw on the best available evidence – that from reviews and research papersand including qualitative and quantitative evidence. This information must be supplemented with local and expert knowledgepolicy informationand proposal specific information.

Howeverthere are examples where the best available evidence has been documentedand in some cases summarised. These are presented below:

Transport
Food and Agriculture
Housing
Waste
Energy
Industry
Urbanization
Water
Radiation
Nutrition and health

What are examples from the transport sector?

Evidence of health impact focus on:

Accidents between motor vehiclesbicycles and pedestrians (particularly children and young people).
Pollution from burning fossil fuels such as particulates and ozone.
Noise from transportation.
Psychosocial effects such as severance of communities by large roads and the restriction of children’s movement.
Climate change due to CO2 emission
Loss of land
Improved physical activity from cycling or walking
Increased access to employmentshops and support services
Recreational uses of road spaces
Contributes to economic development
Vector borne diseases

Documents on the evidence of health impacts from transport policies

WHO Europe website on health impacts of transport
A different route to health: implications of transport policies
BMJ 1999; 318: 1686-1689
WHOConcern for Europe’s tomorrow

What are examples from the food and agriculture sector?

Agricultural production issues and manufacturing

Tobacco farming and its impact on heart diseasestrokecertain cancers and chronic respiratory disease. Including passive smoking and impact of fetal development. Pesticide policies on tobacco crops require consideration.
Changes in land usesoil qualitychoice of cropuse of agricultural labour and occupational health.
Mechanisation of work previously done by handand plantation agriculture.
Fisheries – biotoxinspollutionchemical usewastewaterprocessingand occupational health
Forestry – vector borne diseasesoccupational healthand food security.
Livestock use – vector borne diseasesdrug residuesanimal feedwasteand food security.
Sustainable farming including chemical and energy usebiodiversityorganic production methodsand diversity of foods produced.
Fertiliser use – nitrate levels in foodpollution of waterwaysre-use of agricultural waste.
Water – irrigation use and its impact on river/water-table levels and production outputs.
Pesticide usage and veterinary drugs– legal requirementsbest practiceconsumer issues.
Food packagingpreservation and safetyand avoidance of long storage and travel.

Access toand distribution of food

Household food security – appropriate food being availablewith adequate access and being affordable (location of marketssupermarkets and closure of small suppliers creating food deserts in cities).
Food suppliesincluding national and regional food securityand regional production.
National food security – able to provide adequate nutrition within a country without relying heavily on imported products
Cold-chain reliability – the safety of transporting products that deteriorate microbiologically in the heat.

Dietary patternsdiversity of food available and home productionparticularly:

Fruit and vegetable consumption on reduced strokeheart disease and risk of certain cancers,
Totalsaturated and polyunsaturated fatcarbohydrates and sugars consumption on obesityheart diseasestroke and other vascular diseases.
Alcohol consumption and impact on social effects related to behaviour (traffic accidentswork/home accidentsviolencesocial relationsunwanted pregnancy and STDs)and toxic effects (all-cause mortalityalcoholismcertain cancersliver cirrhosispsychosispoisoninggastritisstrokefetal alcohol syndrome and others).
Micronutrients such as ironvitamin Azinc and iodine and their impact on deficiency syndromes.

Food safety and foodborne illness hazards

Food and water are the major sources of exposure to both chemical and biological hazards. They impose a substantial health risk to consumers and economic burdens on individualscommunities and nations.

Microorganisms such as salmonellacampylobacterE. coli O157listeriacholera.
Viruses such as hepatitis Aand parasites such as trichomonosis in pigs and cattle.
Naturally occurring toxins such as mycotoxinsmarine biotoxins and glycosides.
Unconventional agents such as the agent causing bovine spongiform encephalopathy (BSEor "mad cow disease"),
Persistent organic pollutants such as dioxins and PCBs. Metals such as lead and mercury.
New foods developed from biotechnology such as crops modified to resist pestschanges in animal husbandryantibiotic use and new food additives.

Documents on the evidence of food and agriculture

What are examples from the housing sector?

Evidence of health impacts focus on:

Improvements in housing and improved mental health and general health
The possibility of improved housing leading to rent risesimpacting negatively on health.
Movement of original tenants after housing improvement and therefore not benefiting from the improvements.
Housing tenureoutdoor temperatureindoor air qualitydampnesshousing designrent subsidiesrelocationallergens and dust miteshome accident preventionand fire prevention.
Homelessness.

Housing evidence documents

WHOConcern for Europe’s tomorrow

What are examples around waste management?

Evidence of health impacts focuses on environmental and social determinants related to:

the transmission of agents of infectious disease from human and animal excreta (sanitationhygiene and water-related);
exposure to toxic chemicals in human and animal excreta; and in industrial wastes discharged into the environment;
environmental degradationdirect and indirect impacts on health;
exposure to radioactive wastes;
exposure to health-care wastes;
exposure to solid wastes and involvement in informal waste recycling; and
breeding of disease vectors.

What are examples from the energy sector?

Evidence of health impacts focus on health hazards such as: