tag:theconversation.com,2011:/africa/topics/health-impact-4604/articlesHealth impact – The Conversation2017-05-31T07:51:20Ztag:theconversation.com,2011:article/783022017-05-31T07:51:20Z2017-05-31T07:51:20ZWales is leading the world with its new public health law<figure><img src="https://images.theconversation.com/files/171483/original/file-20170530-30121-xkjpyk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cardiff-wales-united-kingdom-march-15-301185005?src=jQZz0LHgHM0460CSX_AHbA-1-93">MA PHOTGRAPY/Shutterstock</a></span></figcaption></figure><p>When it comes to world-leading health legislation, you might expect it to come from Sweden, which is famous for citizen engagement in the health service, or a large global power. You probably wouldn’t expect it to come out of Wales. And yet, the country’s devolved government is <a href="http://www.walesonline.co.uk/news/health/ams-passed-new-law-means-13044775">close to enacting</a> another innovative law aimed at bettering the health of its people.</p>
<p>Wales is no stranger to being the first of the UK nations to enforce legislation that benefits both human health and the environment. Since October 2011, there has been a minimum 5p charge on carrier bags in the country – a move which was followed by <a href="https://www.theguardian.com/environment/2013/apr/08/northern-ireland-plastic-bag-charge1">Northern Ireland in 2013</a>, <a href="http://www.bbc.co.uk/news/uk-scotland-34575364">Scotland in 2014</a> and <a href="https://theconversation.com/the-5p-carrier-bag-charge-has-paved-the-way-for-other-waste-reduction-policies-64911">England in 2015</a>.</p>
<p>In 2015, a ban on <a href="http://gov.wales/newsroom/health-and-social-services/2015/151001ban/?lang=en">smoking in cars with passengers aged under 18 years old</a> was enacted, which was <a href="http://www.bbc.co.uk/news/health-31310685">again followed by their English neighbours</a>. Scotland enforced <a href="http://www.bbc.co.uk/news/uk-scotland-scotland-politics-38184585">a similar law</a> a year later, while Northern Ireland has recently completed a <a href="http://www.bbc.co.uk/news/uk-northern-ireland-38531586">consultation on its provision</a>.</p>
<p>Nor does it lag behind on a global scale: the pioneering <a href="http://gov.wales/topics/people-and-communities/people/future-generations-act/?lang=en">Well-being of Future Generations (Wales) Act 2015</a> has been described by the United Nations as “<a href="http://gov.wales/newsroom/environmentandcountryside/2015/150429-future-generations-act/?lang=en">world-leading</a>”. Among other things, its seven well-being goals aim to make Wales a healthier place, where physical and mental well-being are maximised and in which choices and behaviours that benefit future health are understood. </p>
<p>Though the new Public Health (Wales) Bill <a href="http://gov.wales/topics/health/nhswales/bill/?lang=en">includes specific provisions</a> for banning smoking in hospital grounds, placing a duty on the Welsh government to produce a national obesity strategy and making pharmacy services more responsive to community needs, the fact that it puts <a href="http://www.who.int/heli/impacts/hiabrief/en/">Health Impact Assessments</a> (HIAs) on a statutory footing is the most interesting and important feature.</p>
<h2>Health in all policies</h2>
<p>This latest public health law will make Wales the first country in the world to have statutory HIAs. At present, only the Australian <a href="http://www.austlii.edu.au/au/legis/tas/consol_act/emapca1994484/s74.html">state of Tasmania</a> and the <a href="http://gov.wales/topics/health/nhswales/bill/?lang=en">Canadian provinces of Quebec and British Colombia</a> have mandatory HIAs. </p>
<p>HIAs are a pre-decision assessment of the effects of proposed action – regulations, policy, programmes or projects – by public bodies on human health. It’s a “health in all policies” approach. HIAs will seek to maximise the positive health effects of the proposed action and will put forward proposals to mitigate the negative effects. The law will apply to, among others, the Welsh government, local authorities and local health boards, and they will be required to publish their HIAs and take account of them when making decisions. </p>
<p>The British Medical Association Cymru Wales has been campaigning for statutory HIAs since 1994: it sees them as <a href="https://www.bma.org.uk/news/media-centre/press-releases/2017/may/public-health-wales-bill">an opportunity</a> to make Wales an international leader in public health – not just of individuals but of entire communities. In their view, it is an opportunity to address the broader environmental factors which influence health. It is a preventative approach to stop ill health occurring in the first place. </p>
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<img alt="" src="https://images.theconversation.com/files/171481/original/file-20170530-30169-4uniff.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/171481/original/file-20170530-30169-4uniff.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/171481/original/file-20170530-30169-4uniff.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/171481/original/file-20170530-30169-4uniff.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/171481/original/file-20170530-30169-4uniff.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/171481/original/file-20170530-30169-4uniff.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/171481/original/file-20170530-30169-4uniff.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Wales is no stranger to innovative health legistlation.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/map-view-wales-362495210?src=WQIK-_oiNZ4svyB1dUBeTg-5-66">sevenMaps7/Shutterstock</a></span>
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<p>The scale of HIAs can vary but they often involve risk assessment, data analysis and a literature review. Stakeholder involvement, such as the involvement of the medical profession and citizen engagement, is also important.</p>
<p>At present, public bodies in Wales are required to carry out numerous impact assessments on things such as equality – so why is another one needed? Quite simply because health is not so directly assessed under these as it would be under the planned HIAs. </p>
<p>The Environmental Impact Assessment (EIA), required under European Union law, for example, ensures that planning decisions are made considering environmental effects. Human health considerations are included, but many think that the EIAs don’t give sufficient consideration to human environmental health issues. In fact, research carried out by BMA UK has found that <a href="https://books.google.co.uk/books?id=2Tv5AQAAQBAJ&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false">only 28% of EIAs</a> give consideration to human health hazards.</p>
<h2>Accountable for health</h2>
<p>HIAs also make provision for individuals to challenge public bodies if they think they are not carrying them out effectively: if they can show they are personally affected by a decision they can bring an action for judicial review. If there are implications for the wider public, then an application for judicial review would have to be brought by a representative group.</p>
<p>In addition, HIAs enforcement could be placed under the power of the future generations commissioner – <a href="https://futuregenerations.wales/sophie-howe/">currently Sophie Howe</a> – a post created by the aforementioned Well-being of Future Generations Act. The commissioner already has the power to review how public bodies are taking account of the long-term impact of their decisions so it would be a natural fit. </p>
<p>There is no shortage of ambition when it comes to the principles underlying public health legislation passed by the Welsh Assembly. It shows a belief in the ability of law to bring about social change. However, laws can produce unintended consequences as well as beneficial effects. If HIAs are to be a success then there will have to be commitment through political will, effective management at all levels of the HIA process and active participation from stakeholders – including citizens. Ultimately, they can only be as good as the methods which are used to identify health hazards. </p>
<p>But this could be a great leap forward in protecting the health of the nation, and one which the UK and rest of the world would do well to consider following.</p><img src="https://counter.theconversation.com/content/78302/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard Owen does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Wales is about to become the first country to put health first in all public decisions.Richard Owen, Associate professor, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/683292016-11-07T06:17:44Z2016-11-07T06:17:44ZCommunity organisations lack the funding and data to measure their impact<p>Community organisations are struggling to measure the impact they are having due to a lack of funds and data availability, <a href="http://www.csi.edu.au/media/uploads/Social_Impact_Series_6.pdf">new research has found</a>. It shows three quarters of community sector charities are trying to measure their outcomes and have increased this effort in the last five years. </p>
<p>However many are held back. Out of our survey participants of 190 community sector organisations, 90% cited a lack of funding and resources as the most significant barrier to measuring outcomes. Second to this was the lack of an established methodology and tools to assist them in measuring.</p>
<p>These community organisations saw the most important driver for measuring impact was not to meet the requirements of funders (important though that is), but to improve their services; to achieve their mission more effectively.</p>
<p><a href="http://australiancharities.acnc.gov.au/visualisations/explore-all-charities/">At last count</a>, there were nearly 10,000 registered housing & development, health, and social services charities in Australia. These organisations had a combined income of A$46 billion and employed half a million people. They are in the front line of the delivery of social services. </p>
<p>The pressure is on for these organisations to show their impact as the government takes a <a href="https://www.dss.gov.au/review-of-australias-welfare-system/australian-priority-investment-approach-to-welfare">priority investment approach</a> to welfare. This is where government spending decisions on social programs are taken on the basis of the long-term economic and social impact of those programs (or more narrowly, the long-term budgetary impact of those programs).</p>
<p>When community organisations are funded to measure their outcomes, significant progress is made. There is a <a href="http://resultsaccountability.com/about/what-is-results-based-accountability/">well accepted framework</a> these organisations can use to break down what they do into individual service units with outcomes to be measured. This also involves data collection and assessment. In our study, 32% of community organisations had implemented this framework. </p>
<p>One example of a community sector measuring its outcomes is The Smith Family and its <a href="https://www.thesmithfamily.com.au/what-we-do/how-we-help/learning-for-life">Learning for Life program</a>. This program supports disadvantaged families by covering education-related expenses that aren’t covered by schools, as well as promoting long-term participation in education to Year 12 and subsequent engagement in education, training and employment.</p>
<p>As a result of establishing a data collection system and a research and evaluation framework around that, The Smith Family was able to demonstrate the effectiveness of the program. It improved school attendance, Year 12 completion and subsequent engagement in education, training and employment. This also increases their chance of securing funding and philanthropic support.</p>
<p>However beyond this specific framework, organisations need to use existing population-level administrative data better to understand the impact of social programs. Our survey shows this is not being done and yet there is enormous potential in this data and its analysis.</p>
<p>For example <a href="http://www.csi.edu.au/media/uploads/AHURI_Final_Report_No265_What-are-the-health-social-and-economic-benefi..._2edQIWr.pdf">our recently released study of programs</a> delivered under the Council of Australian Government’s <a href="http://www.coag.gov.au/housing_and_homelessness">National Partnership Agreement on Homelessness (NPAH)</a> showed the program’s impact by linking the health records of program participants with their public housing records. From this we were able to examine the journeys of program participants before and after entering public housing.</p>
<p>The study revealed that those formerly homeless people accessing public housing through the NPAH programs, for the most part, sustained their housing. And as they did so, we found reductions in the use of emergency departments, in nights in hospital and in psychiatric care. This means the program would meet the aims of the government’s priority investment model, as cost savings were made to the public purse. </p>
<p>A challenge facing public policy is to ensure that where administrative data exists, records can be linked and in “real time”. This is so that policy makers are aware of the impact of the program, as it is occurring. A second challenge is to enable community organisations to access such data, or at least provide relevant organisation-level results, so that the impact of their own efforts can be better assessed. </p>
<p>The use of linked administrative data helps to support the task of impact assessment. But it does not remove the need for community organisations to measure their outcomes themselves. There is a large array of program outcomes that are not covered in population-level administrative data and can only be obtained at the organisational level. </p>
<p><a href="http://www.csi.edu.au/media/uploads/Social_Impact_Series_6.pdf">In our study</a>, we identified five key areas that need to be addressed in order for organisations to measure their outcomes, these were: </p>
<ol>
<li>Funders requiring more outcomes reporting, with additional financial support</li>
<li>Open data from government, particularly in relation to linked administrative data, common infrastructure for data collection and a core set of common outcomes items.</li>
<li>The need for standardised language in outcomes reporting so that all stakeholders can understand them</li>
<li>Professional development within community service organisations and guidance on how to use standard tools.</li>
</ol>
<p>If community organisations and government can address these areas, the social impact of organisations will be clearer.</p><img src="https://counter.theconversation.com/content/68329/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Flatau received funding from the Bankwest Foundation and from the Australian Housing and Urban Research Institute (AHURI) in relation to research cited in the article. Co-authors on the Bankwest Foundation study relating to community sector outcomes measurement were Ami Seivwright, Sarah Adams and Claire Stokes. Co-authors on the AHURI study on the impact of NPAH programs were Lisa Wood, Kaylene Zaretzky, Sarah Foster, Shannen Vallesi, and Darja Miscenko.</span></em></p>Community organisations are trying to measure their impact but lack the funding and data availability to do it properly, new research finds.Paul Flatau, Director, Centre for Social Impact, UWA Business School, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/110202013-02-19T00:02:10Z2013-02-19T00:02:10ZWired by sound: the long-term impacts of constant noise<figure><img src="https://images.theconversation.com/files/19436/original/8xj3k6zn-1358746093.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Men account for 61% of the health expenditure on hearing loss.</span> <span class="attribution"><span class="source">charlene trapp</span></span></figcaption></figure><p>I have a favourite café that I have patronised regularly for many years. It’s often crowded and noisy and, until this year, I coped with that by taking my coffee early – before the café ambience became painfully loud. But sadly, I can’t go there any more. In addition to their noisy background, they have now introduced muzak, and my tolerance for pain and discomfort has been exceeded.</p>
<p>Discomfort is only the beginning – excessive environmental noise is actually very bad for your health. It’s <a href="http://www.hearing.com.au/upload/media-room/Hearing-loss-in-Australia.pdf">responsible for over a third</a> of hearing loss in Australia. Indeed, the <a href="http://www.audiology.asn.au/pdf/listenhearfinal.pdf">economic costs</a> alone of hearing loss have been calculated at almost A$12 billion dollars a year. </p>
<p>Even a temporary loss of hearing acuity can become permanent after consistent exposure to noise. This is a major burden for the whole of society. Men account for 61% of the health expenditure on hearing loss and women account for the rest.</p>
<p>And things are about to get worse – the prevalence of hearing loss is expected to increase from 17% now to 28% by 2050. </p>
<p>Loud rock music is probably the most obvious example of noise that damages hearing. But cafes and restaurants are also full of noise, loud speech, and loud laughter. The ceilings are low, the walls have no insulation, and the floors are bare – all of this creates a space that amplifies noise. </p>
<p><a href="http://www.safeworkaustralia.gov.au/sites/swa/about/publications/Documents/539/Occupational_Noiseinduced_Hearing_Loss_Australia_2010.pdf">Anything above 85 decibels</a> can cause permanent hearing loss and many music venues exceed this level. What’s more, music entertainment and night clubs use extreme amplification, which can cause <a href="http://www.nidcd.nih.gov/health/hearing/pages/noise.aspx">incremental hearing damage</a>. </p>
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<img alt="" src="https://images.theconversation.com/files/19437/original/9k8tcw3m-1358746487.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/19437/original/9k8tcw3m-1358746487.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/19437/original/9k8tcw3m-1358746487.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/19437/original/9k8tcw3m-1358746487.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/19437/original/9k8tcw3m-1358746487.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/19437/original/9k8tcw3m-1358746487.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/19437/original/9k8tcw3m-1358746487.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The precise impacts of noise on critical child learning capacities haven’t been measured.</span>
<span class="attribution"><span class="source">Mary/Flickr</span></span>
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<p>Noise affects attention, concentration and thinking. Given the high levels of noise in which we live and work, is it any wonder that Australia has a high prevalence of people with hearing impairment? <a href="http://www.audiology.asn.au/">One person in four</a> is likely to develop permanent hearing loss as a consequence of excessive and damaging levels of noise.</p>
<p>The precise impacts of noise on critical child learning capacities haven’t been measured and require urgent attention so we can know what needs to be done to make the hearing environment a healthier one. Indeed, we need to be especially worried about the health and well-being of children in the longer term. </p>
<p>Hearing loss usually develops slowly and can reach the critical stage before the young person is aware of it.</p>
<p>Repeated exposure to noise at entertainment venues, via ear phones and electronic devices, heavy traffic, and loud conversation, among other things, puts young people at risk of ongoing damage to their hearing, which will worsen with age. This will affect their communication, learning capacities, and capacity to function well in the community.</p>
<p>There’s no medical treatment for hearing damage (apart from hearing aids), and parents seem unaware of the risks and the need to protect their children from excessive noise exposure. The problems urgently need more research.</p>
<p>Prevention is the best option. Eliminating or at least controlling all noise sources to harmless levels is needed to prevent environmentally-induced hearing impairment.</p><img src="https://counter.theconversation.com/content/11020/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Margot Prior does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>I have a favourite café that I have patronised regularly for many years. It’s often crowded and noisy and, until this year, I coped with that by taking my coffee early – before the café ambience became…Margot Prior, Honorary Professor, Melbourne School of Psychological Sciences, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.