Behavioral interventions to reduce nickel exposure in a nickel processing plant.

Nickel is a widely-used material in many industries. Although there is enough evidence that occupational exposure to nickel may cause respiratory illnesses, allergies, and even cancer, it is not possible to stop the use of nickel in occupational settings. Nickel exposure, however, can be controlled and reduced significantly in workplaces. The main objective of this study was to assess if educational intervention of hygiene behavior could reduce nickel exposure among Indonesian nickel smelter workers. Participants were randomly assigned to three intervention groups (n = 99). Group one (n = 35) received only an educational booklet about nickel, related potential health effects and preventive measures, group two (n = 35) attended a presentation in addition to the booklet, and group three (n = 29) received personal feedback on their biomarker results in addition to the booklet and presentations. Pre- and post-intervention air sampling was conducted to measure concentrations of dust and nickel in air along with worker's blood and urine nickel concentrations. The study did not measure significant differences in particles and nickel concentrations in the air between pre- and post-interventions. However, we achieved significant reductions in the post intervention urine and blood nickel concentrations which can be attributed to changes in personal hygiene behavior. The median urinary nickel concentration in the pre-intervention period for group one was 52.3 µg/L, for group two 57.4 µg/L, and group three 43.2 µg/L which were significantly higher (p< = 0.010) than those measured in the post-intervention period for each of the groups with 8.5 µg/L, 9.6 µg/L, and 8.2 µg/L, respectively. A similar pattern was recorded for serum nickel with significantly (p < 0.05) higher median concentrations measured in the pre-intervention period for group one 1.7 µg/L, and 2.0 µg/L for group 2 and group 3 compared with the post intervention median serum nickel levels of 0.1 µg/L for all groups. The study showed that educational interventions can significantly reduce personal exposure levels to nickel among Indonesian nickel smelter workers.

What makes health impact assessments successful? Factors contributing to effectiveness in Australia and New Zealand.

BACKGROUND: While many guidelines explain how to conduct Health Impact Assessments (HIAs), less is known about the factors that determine the extent to which HIAs affect health considerations in the decision making process. We investigated which factors are associated with increased or reduced effectiveness of HIAs in changing decisions and in the implementation of policies, programs or projects. This study builds on and tests the Harris and Harris-Roxas' conceptual framework for evaluating HIA effectiveness, which emphasises context, process and output as key domains. METHODS: We reviewed 55 HIA reports in Australia and New Zealand from 2005 to 2009 and conducted surveys and interviews for 48 of these HIAs. Eleven detailed case studies were undertaken using document review and stakeholder interviews. Case study participants were selected through purposeful and snowball sampling. The data were analysed by thematic content analysis. Findings were synthesised and mapped against the conceptual framework. A stakeholder forum was utilised to test face validity and practical adequacy of the findings. RESULTS: We found that some features of HIA are essential, such as the stepwise but flexible process, and evidence based approach. Non-essential features that can enhance the impact of HIAs include capacity and experience; 'right person right level'; involvement of decision-makers and communities; and relationships and partnerships. There are contextual factors outside of HIA such as fit with planning and decision making context, broader global context and unanticipated events, and shared values and goals that may influence a HIA. Crosscutting factors include proactive positioning, and time and timeliness. These all operate within complex open systems, involving multiple decision-makers, levels of decision-making, and points of influence. The Harris and Harris-Roxas framework was generally supported. CONCLUSION: We have confirmed previously identified factors influencing effectiveness of HIA and identified new factors such as proactive positioning. Our findings challenge some presumptions about 'right' timing for HIA and the rationality and linearity of decision-making processes. The influence of right timing on decision making needs to be seen within the context of other factors such as proactive positioning. This research can help HIA practitioners and researchers understand and identify what can be enhanced within the HIA process. Practitioners can adapt the flexible HIA process to accommodate the external contextual factors identified in this report.

The effectiveness of health impact assessment in influencing decision-making in Australia and New Zealand 2005-2009.

BACKGROUND: Health Impact Assessment (HIA) involves assessing how proposals may alter the determinants of health prior to implementation and recommends changes to enhance positive and mitigate negative impacts. HIAs growing use needs to be supported by a strong evidence base, both to validate the value of its application and to make its application more robust. We have carried out the first systematic empirical study of the influence of HIA on decision-making and implementation of proposals in Australia and New Zealand. This paper focuses on identifying whether and how HIAs changed decision-making and implementation and impacts that participants report following involvement in HIAs. METHODS: We used a two-step process first surveying 55 HIAs followed by 11 in-depth case studies. Data gathering methods included questionnaires with follow-up interview, semi-structured interviews and document collation. We carried out deductive and inductive qualitative content analyses of interview transcripts and documents as well as simple descriptive statistics. RESULTS: We found that most HIAs are effective in some way. HIAs are often directly effective in changing, influencing, broadening areas considered and in some cases having immediate impact on decisions. Even when HIAs are reported to have no direct effect on a decision they are often still effective in influencing decision-making processes and the stakeholders involved in them. HIA participants identify changes in relationships, improved understanding of the determinants of health and positive working relationships as major and sustainable impacts of their involvement. CONCLUSIONS: This study clearly demonstrates direct and indirect effectiveness of HIA influencing decision making in Australia and New Zealand. We recommend that public health leaders and policy makers should be confident in promoting the use of HIA and investing in building capacity to undertake high quality HIAs. New findings about the value HIA stakeholders put on indirect impacts such as learning and relationship building suggest HIA has a role both as a technical tool that makes predictions of potential impacts of a policy, program or project and as a mechanism for developing relationships with and influencing other sectors. Accordingly when evaluating the effectiveness of HIAs we need to look beyond the direct impacts on decisions.

Health impact assessment in Mongolia: current situation, directions, and challenges.

Many developing countries have limited capacity to adequately assess and manage health impacts associated with environmental change. In Mongolia, methodologies to introduce health impact assessment (HIA) as part of the environmental impact assessment (EIA) process have been investigated, and a mechanism to incorporate HIA into the current EIA process is proposed. Some challenges to the implementation of HIA are discussed. The country is now in a position to incorporate HIA as part of the approvals process for development projects. Given the recent growth in population, industrial development, and urbanization together with the interest from international mining companies in the resources of the country, it is important for Mongolia to have such tools in place in order to take advantage of economic growth while improving health and well-being outcomes for the population.

Assessing health impacts within environmental impact assessments: an opportunity for public health globally which must not remain missed.

Within the member states of the United Nations 190 of 193 have regulated Environmental Impact Assessments (EIA) which is a systematic process to prevent and mitigate the potential environmental impacts of industry development projects before these occur. However, the routine and comprehensive assessment of health impacts within EIAs remains underdeveloped. Focusing, as an example, on the risks to global health from the global shift in the mining industry towards Low and Middle Income Countries LMIC), this viewpoint details why connecting with EIA is an essential task for the health system. Although existing knowledge is out of date in relation to global practice we identify how health has been included, to some extent, in High Income Country EIAs and the institutional requirements for doing so. Using arguments identified by industry themselves about requiring a 'social license to operate', we conclude that EIA regulations provide the best current mechanism to ensure health protection is a core aspect in the decision making process  to approve projects.

Characteristics of health impact assessments reported in Australia and New Zealand 2005-2009.

OBJECTIVE: To describe the use and reporting of Health Impact Assessment (HIA) in Australia and New Zealand between 2005 and 2009. METHODS: We identified 115 HIAs undertaken in Australia and New Zealand between 2005 and 2009. We reviewed 55 HIAs meeting the study's inclusion criteria to identify characteristics and appraise the quality of the reports. RESULTS: Of the 55 HIAs, 31 were undertaken in Australia and 24 in New Zealand. The HIAs were undertaken on plans (31), projects (12), programs (6) and policies (6). Compared to Australia, a higher proportion of New Zealand HIAs were on policies and plans and were rapid assessments done voluntarily to support decision-making. In both countries, most HIAs were on land use planning proposals. Overall, 65% of HIA reports were judged to be adequate. CONCLUSION: This study is the first attempt to empirically investigate the nature of the broad range of HIAs done in Australia and New Zealand and has highlighted the emergence of HIA as a growing area of public health practice. It identifies areas where current practice could be improved and provides a baseline against which future HIA developments can be assessed. IMPLICATIONS: There is evidence that HIA is becoming a part of public health practice in Australia and New Zealand across a wide range of policies, plans and projects. The assessment of quality of reports allows the development of practical suggestions on ways current practice may be improved. The growth of HIA will depend on ongoing organisation and workforce development in both countries.

Climate change and air quality: the potential impact on health.

The objectives of the study were to: consider the potential health impacts in Australia and the region arising from changes in air quality occurring as a result of climate change, identify vulnerable groups and potential adaptation measures and discuss the implications for policy. The authors provide an overview of international and national information on the potential health impacts of air pollutants that would most likely be affected by climate change and a discussion of the policy implications. Climate change is likely to have an impact on levels of ozone and possibly particulates, both of which are associated with increased mortality and a range of respiratory and cardiovascular health effects. One of the implications is therefore a possible increase in adverse health effects due to air pollutants. Regional health impact assessments of climate change should address the issue of air quality, consider current coping capacity, and determine the need for adaptation, particularly for vulnerable groups. Implications for policy include the need for improved modeling and forecasting of air pollutant levels, increased efforts to reduce emissions of air pollutants, continued monitoring of air pollutant levels, and monitoring of the incidence of health effects associated with air pollutants in all countries in the region.

A survey of occupational exposure to blood and body fluids in physiotherapists in Western Australia.

The aim of this pilot project was to investigate the occurrence of occupational exposure to blood and body fluids in registered physiotherapists in Western Australia. Surveys were sent to physiotherapists with questions regarding personal background, exposure characteristics, and contributing factors included. Descriptive statistical methods were used to identify the area of practice posing the highest risk of exposure to physiotherapists. The authors found that 56.1% of surveyed physiotherapists recorded one or more exposures within the past 5 years. Work in hospitals was found to carry the highest rate of exposure for the physiotherapy profession. Other areas of practice, including community work, private practice, nursing homes/hostels, and work at sporting events carry comparable but lower risks of exposure. In private practice, 50% of exposures were associated with acupuncture. In nursing homes, 60% of exposures were brought on by exposure to contaminated materials, whereas in the community setting most exposures (64%) were attributed to unpredictable/uncontrollable situations. At sporting events, 90% of all exposures were associated with already existing sources of blood and body fluids (wounds). Within the hospital setting, the 3 dominant immediate causes reported were unpredictable situations (33.3%), existing sources (28.4%), and procedural causes (22.2%). The use of personal protective equipment for prevention of exposure is investigated and discussed. Data collected for this survey were not enough to draw conclusive assumptions regarding hazard management. A repeat of this study on a larger scale may provide physiotherapists with the tools and knowledge to minimize the likelihood of exposure and harm arising from exposure.