A Challenge for Public Health in the UK - Coursework Example

Introduction The correlation between development and the health of the population has been widely recognized and there have been number of researcheswhich confirmed this connection. The policy of the government which relates to the development of a particular area has thus either direct or indirect connections with the health of the population (BMJ, 1996). Therefore an evidence based policy making approach has to be followed which would ultimately lead to improvements in the health indicators. This is where Health Impact Assessment (HIA) comes into play. HIA is a combination of processes to assess the consequences that a particular policy could bring forth on the health of the population. It must be noted here that the policy being assessed for its health impacts need not be one which has direct objectives relating to health (Scott, 1997). In other words, HIA estimates the potential changes that a particular project could directly or indirectly bring forth on the respective population. In the UK context, there have been a lot of initiatives which has been pushing HIA as an integral part of the national and the regional policy (BMA, 1998). A structured framework is followed to collect evidences for the potential impacts of a proposal on health. A major advantage here is that the assessment is largely interdisciplinary in nature, considering wide range of aspects directly and indirectly associated with health. For instance, the cultural, social, economic and environmental impacts of the proposal will be measured and is assessed against the potential impact that these can have on health of the local population. Another major advantage is that HIA takes into account the opinions and expectations of the local population who are to be affected by the changes that the policy would create. This approach is of high sociological advantage as the local voices will be heard. The analysis based on these expectations and opinions influences the policy decision. Thus the policy can be expected to have local participation in its planning. However, the interdisciplinary nature of the assessment makes it complex. The wide range of disciplines associated with the assessment makes the difficult to be covered comprehensively. It is also difficult to establish the interdisciplinary linkages with health as observed by the assessment. Moreover the subjective nature of the assessment has been criticized for its limitation in relating to evidences (Parry, 2001) Profile of the development scenario being assessed There is a wide range of systems and communities which are associated with the project being analyzed here. The proposal in this case is that a developmental company has proposed a project to build 700 houses over the next 10 years. The proposed site is a very fertile farm land and lies adjacent to coastal village. Stakeholder Profile A stakeholder of a project or a resource is person or entity dependent on the project or the resource. In simpler language stakeholders are beneficiaries, supporters, opponents, resource providers or vulnerable groups associated with the resource. In an ideal situation the largest stakeholder of a resource must the community itself. In this case, where homes are being built in the farmland a number of resources on which the local community is dependent on will be exploited by the project. Around any resource there will be a network of such stakeholders who will be associated to it. It is a natural phenomenon to have many number of stakeholders associated to any biological or physical system. This also means a symbiosis amongst the stakeholders and the resource. For instance, the community associated with traditional fishing as an occupation is a stakeholder of shore. They use the space and the bio-system of the sea and the shore to run their traditional occupation. However, they ensure to maintain a balance in the utilization of resources so that it does not affect the natural resources. Problems arise when this balance is breached. This often happens when the stakeholders with acute commercial interest gets associated with the resources. Thus it is important that the stakeholders are identified and they are consulted for their opinions and concerns. The stakeholders are profiled here according to their location, characteristics, common interest and behaviors (Scott, 1998) The local community The village has 1600 residents. They are spread out in 631 dwellings. Their major occupation is either fishing or allied activities. The housing availability in the village is limited. Moreover the cost of the available housing facility is also unaffordable for the local people. The economic outturn from fishing and allied industries has been reported to be very less. Thus there is an opportunity to avail new housing facilities considering the current limitation of supply of housing in the village. The unemployment rate is reported to be higher than the national average. The building project will be utilizing a number of resources currently being enjoyed by the community. For instance, the narrow congested roads will be used for transportation of goods for construction. The project will also use the human resource available in the village for construction and other employments which are generated. Thus the local community could be beneficiaries, resource providers and opponents to an extent. The Development Company The development company is the major beneficiary out of the stakeholders. They would exploit the resources of the village including the fertile farm land to establish their building project. As a business concern they have commercial interests. The resources exploited will be converted to sellable commodities. Apart from the money value of the project, the natural setting of the village also will be exploited commercially. It will be noted here that the project is being proposed in a coastal village. The scenic capital of the village will be commercially explored to be benefited by the company on a commercial basis. Local Authorities Another major stakeholder of the project is the local authorities. They may be mapped as the resource provider, supporter and beneficiary to an extent. The local authority is to channelize all the resources required for the implementation of the project. The proposal has to be sanctioned by the local authorities taking into consideration its compliance with local legislations and other environmental, economic and social stipulations. The development project would generate revenue for the local authorities in terms of taxes. This would further go back to the local people. Thus the role of the local authorities becomes as that of a beneficiary. The HIA Steering Committee In the Scottish context, this is the stakeholder which has special reference to the Health Impact Assessment. An interdisciplinary committee is constituted to analyze the direct or indirect impacts on the health of the community (Winters, 1998). This stakeholder‘s role has contextual reference to the findings of the HIA. For instance, in some cases the committee would be opponents and in other contexts it would act as promoters. This however would directly depend on the nature of the proposal and the conclusions of the assessment Local Entrepreneurs and Institutions There are few local institutions and small scale entrepreneurial setups within the village. These include a primary school. The school will be a beneficiary for the project as the new settlers would need an institution to teach their children. There is a part time doctor, a butcher, a post office, a baker, a chemist and a general convenience store. These institutions and the local entrepreneurs will be beneficiaries of the project. Information Collection Both qualitative and quantitative methodologies will be followed to source information for the assessment. The demographic data can be collected from local authorities from the quantitative sources available with them. Quantitative data to understand the permissible levels of variables with reference to environment and economics can be sourced from secondary sources. However, with reference to the expectations and the opinions of the local people, there has to be surveys and interviews conducted to collect these qualitative information. Focus group discussions and stakeholder meetings are to be conducted to have in depth understanding on the people’s perceptions of the developmental projects. The concerns and the expectations of the local people will have to qualitatively analyzed and compared against the proposed outcomes of the projects. The information on the detailed framework of the project and the measures to counter the environmental, cultural and social imbalances that the project is expected to bring forth has to be sourced from the policy document. Evaluation The Commission of the European Union in its article 129 of the European Union Treaty "requires the Commission to check that proposals for policies, and implementing measures and instruments, do not have an adverse impact on health, or create conditions which undermine the promotion of health."(CES, 1995). Further, several European policies on this accord points out that the HIA has to be based on a generic model of health covering economic, political, social , environmental, political and psychological factors connected with the stakeholders (SSH, 1999). This evaluation thus broadly covers these topics to assess the impacts of the housing development project in the overall health of the community. Physical Environment The project is expected to bring forth massive changes in the physical environment of the local community. The narrow road that connects through the village is expected to have a widening as it connects to a new developmental project. This would resultantly develop the transportation facilities. However, the traffic through the congested village roads would massively increase as a result of this. This would affect the air quality and would result in increased noise. Kunzli (2000) has noted that air pollution can be causative of mortality and morbidity. Considering the limited carrying capacity of the roads and the village altogether, this would adversely affect the villagers in a long term. The fertile farmable land which is being converted into building spaces would adversely affect the physical environment of the village. The biological productivity of the land goes down immensely in this case. Moreover, the environmental balance of the village gets disturbed. It must be noted here that for a community which associates itself with fishing, the perceptions on the physical environment to which they are associated with is very important. The occupation and the allied industry itself would need a particular setting as far as the physical setting is concerned. Massive changes in this would further affect the traditional occupation to which the local community is connected with. The project is to increase the amount of waste being generated in the village. In a longer term this is to create health issues within the village. Thus it is important that there must be proper waste management mechanisms. There are evidences available in the Scottish context that Housing Improvement Projects has significant adverse effect on the general health of the local population (Ambrose, 2000) Psychological Environment There are clear indicators about the social setup of the village. The 1600 residents are living in 631 dwellings. This suggests the social structure of the community. The nature of their major occupation requires them to be closely networked with each other. The physical and the psychological bonding of this network and the access to this network will be disturbed on implementation of the housing proposal (Fried, 1966). Studies which analyzed the impacts of improved housing has reported that improved housing would reduce the feeling of isolation and improve feeling of security, recognition and belonging (Halpern, 1995). However, it must be noted here that the residential facilities which are already available in the village have been reported to be unaffordable to the local people. Thus it can be inferred that the existing economic setup of the village won’t allow its residents to be in a position to own the newly proposed houses. This would bring in new people into the village who will have more economic resources than the villagers. This would in turn result in the social exclusion of the villagers which would reflect badly on their self respect and resultantly their psychological health in a long term (Wilkinson, 1196). Exposure to people who would get settled in the village has the potential improve the social capital of the villagers (Woodin, 1996) However, the risk economic and cultural exclusion would prevent this from happening. Contrary to this, Blackman (2001) referring to a case study based in Europe has reported that the consistency in the pattern of improvements in the psychological health suggests that that improved housing and neighborhood would result in gains in mental health. Public Services The public services in including the health care service will have to improve to carry the requirements of the increased population. As of the date there is a primary school, a part time doctor and chemist there in the village. The project in this reference is going to have a direct impact on the health services. The health care facility won’t have the capacity to cater for a large population as it only has a part time doctor. The primary school will also face resource crunch with reference to the increased population. The impacts of these changes would be indirect and delayed in nature (Morgan, 1998) Personal Behavior There is a large possibility that the local population will divert themselves from their traditional occupations. This assumption is based on the observation that fishery is already not profitable in the village. It is true that the new proposal would bring in a lot of resources in terms of job opportunities. However, this would further divert them from the local means of living. This would largely affect their personal behavior and lifestyle (Evans et al., 1994; Marmot, 1998). Conclusion & Recommendations The housing development project which has been proposed in the village is expected to cause significant changes in the environmental, psychological, social, cultural and economic indicators of the village and the local population. The local population, Development Company, local authorities, HIA steering committee, local entrepreneurs and local institutions are the major stakeholders which were identified to be affected by the developmental project. A detailed profiling of the stakeholders was done to evaluate the possible impacts on the stakeholders. In general it was observed that there could be both positive and negative changes to the physical environment of the village. A major drawback here is that fertile land is being converted as housing plots. The HIA would indicate this would result in negative health outcomes of the local community on a long term. Thus a recommendation in this regard is that the agricultural productivity of the area must not be imbalanced due to the project. This recommendation requires attention as the salinity in the coastal belt would naturally limit the area of land which is fertile. Thus any action resulting in reduction of biological productivity of the land is irreversible. Another recommendation is that the project must have provisions to sustainably mange the extra waste being produced as a result of the project. The project also should not in any case restrict the access of the local people to their means of livelihood. There has to be restrictions on the building processes which may result in noise and air pollution. Projects to ensure the social inclusion of the local people has to be incorporated as a social responsibility of the developers. Similarly, there has to be promotional programmes to encourage the traditional occupation and sustain the industries in relation with it. References Ambrose, P., 2000, A drop in the ocean; the health gain from the Central Stepney SRB in the context of national health inequalities. London: The Health and Social Policy Research Centre, University of Brighton Blackman, T., Harvey, J. Lawrence, M., et al. 2001, Neighbourhood renewal and health: evidence from a local case study. Health & Place 7,p.93–104. British Medical Association., 1998, Health & Environmental Impact Assessment: London: Earthman Publications BMJ., 1996. Health Impact Assessment, BMJ Group, ,[Online] Available at[Acessed 20 March 21, 2013] Commission of the European Communities.,1995, Report from the commission to the council, the European parliament and the economic and social committee on the integration of health protection in community policies. Brussels: CEC, 1995. Evans, R. G., Barer, M. & Marmor, T. R. ,1994., Why are some People Healthy and Others not—the Determinants of Health of Populations., New York: Aldine de Gruyteran, D. (ed.) ,1998).Health and Environmental Impact Assessment. Earthscan Publications Ltd, London, UK. Fried M, 1996., Grieving for a lost home. In: Wilson J, ed. 1996 Urban Renewal. Cambridge, MA: MIT Press Halpern, D.,1995. Improving mental health through the environment: a case study. In: Halpern D, ed. 1995. Mental health and the built environment: more than bricks and mortar? London: Taylor and Francis Kunzli et al., 2000. Public-health impact of outdoor and traffic-related air pollution: a European assessment, THE LANCET , 356 (September 2), p.795- 801 Marmot, M. G., 1998, Improvement of social environment to improve health. Lancet, 351, p. 57–60. Parry J. 2001, Prospective health impact assessment: pitfalls, problems, and possible ways forward. 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