Health Impact Assessment in protected areas: a proposal for urban contexts in Brazil.

The use of Health Impact Assessment (HIA) in the establishment of an urban protected area can enhance the positive impacts and mitigate the negative impacts resulting from its implementation. Brazil hosts some of the most important biodiversity hotspots in the world and the HIA may benefit biodiversity and human health. These areas are commonly created without any preceding survey to assess their impacts on health. Protected areas located in urban zones are essential to maintain environmental balance and quality of life in cities. It promotes positive impacts on health, providing ecosystem services and salutogenic benefits. However, they can generate negative impacts such as the violation of human rights, property speculation, spread of vectorial diseases, and psychosocial stress. Based on the identification of the potential impacts of urban protected areas on health and best practices, this qualitative and exploratory study justifies the use of HIA in urban protected areas, especially in the Brazil, and indicates the main elements for the construction of a methodological approach to contribute to the Sustainable Development Goals and one of its alternatives, the Buen Vivir approach.

Current status and influencing factors of policy identification in health impact assessment: a case study of Zhejiang Province.

BACKGROUND: Health impact assessment (HIA) is a procedure, method and tool for evaluating the potential health impacts of policies, plans and construction projects, as well as the distribution of these impacts on population. Majority of international studies on health impact assessment have focussed on conceptual papers or case evaluations, neglecting participants' views on policies. METHODS: A semi-structured interview with 30 health impact assessment experts was employed in this study, and the Nvivo software was utilized to analyse factors that influence policy identification. Subsequently, a multi-stage stratified random sampling method was adopted to survey 655 pilot staff members involved in health impact assessment in Zhejiang Province. Descriptive statistics were used to describe the current status and identify the factors influencing policy identification. In addition, hierarchical linear regression analysis and structural equation modelling were employed to determine the relationship between policy identification and influencing factors. RESULTS: Statistically significant differences were found among participants in the level of identification of policies across three dimensions. The policy sentiment dimension had the highest score (4.137 ± 0.664), followed by policy cognition (4.075 ± 0.632) and policy evaluation (3.631 ± 0.797) dimensions. Subject trust had a positive impact on policy cognition (ß = 0.503, P < 0.001), policy sentiment (ß = 0.504, P < 0.001) and policy evaluation (ß = 0.465, P < 0.001). Procedural justice had a positive impact on policy sentiment (ß = 0.085, P < 0.01) and policy evaluation (ß = 0.084, P < 0.05), but not policy cognition (ß = 0.056, P > 0.05). Policy identification is influenced by age and average monthly salary among other factors. CONCLUSION: These results highlight the importance of subjective trust and procedural justice in policy identification of health impact assessment. They provide valuable insights to developing interventions to overcome barriers to the implementation and enhancement of global identification of policies. Going forward, cross-sectoral synergies, enhanced international communication and training to increase participants' trust in the policy should be optimized to improve health impact assessment. Additional measures should be taken, such as ensuring seamless communication channels, embedding health impact assessment in administrative mechanisms, and establishing strong oversight and grievance mechanisms to improve fairness and transparency in the implementation and results of health impact assessment.

Model Choice for Quantitative Health Impact Assessment and Modelling: An Expert Consultation and Narrative Literature Review.

BACKGROUND: Health impact assessment (HIA) is a widely used process that aims to identify the health impacts, positive or negative, of a policy or intervention that is not necessarily placed in the health sector. Most HIAs are done prospectively and aim to forecast expected health impacts under assumed policy implementation. HIAs may quantitatively and/ or qualitatively assess health impacts, with this study focusing on the former. A variety of quantitative modelling methods exist that are used for forecasting health impacts, however, they differ in application area, data requirements, assumptions, risk modelling, complexities, limitations, strengths, and comprehensibility. We reviewed relevant models, so as to provide public health researchers with considerations for HIA model choice. METHODS: Based on an HIA expert consultation, combined with a narrative literature review, we identified the most relevant models that can be used for health impact forecasting. We narratively and comparatively reviewed the models, according to their fields of application, their configuration and purposes, counterfactual scenarios, underlying assumptions, health risk modelling, limitations and strengths. RESULTS: Seven relevant models for health impacts forecasting were identified, consisting of (i) comparative risk assessment (CRA), (ii) time series analysis (TSA), (iii) compartmental models (CMs), (iv) structural models (SMs), (v) agent-based models (ABMs), (vi) microsimulations (MS), and (vii) artificial intelligence (AI)/machine learning (ML). These models represent a variety in approaches and vary in the fields of HIA application, complexity and comprehensibility. We provide a set of criteria for HIA model choice. Researchers must consider that model input assumptions match the available data and parameter structures, the available resources, and that model outputs match the research question, meet expectations and are comprehensible to end-users. CONCLUSION: The reviewed models have specific characteristics, related to available data and parameter structures, computational implementation, interpretation and comprehensibility, which the researcher should critically consider before HIA model choice.

Walkability and urban built environments-a systematic review of health impact assessments (HIA).

BACKGROUND: Urban environments are important determinants of human health. The term walkability summarizes features of the urban built environment that promote walking and other types of physical activity. While the beneficial effects of active and public transport have been well established, the health impact of other features of walkability are less well documented. METHODS: We conducted a systematic review of health impact assessments (HIAs) of walkability. Studies were identified through PUBMED and Science Direct, from two German websites related to urban health and reference tracking. Finally, 40 studies were included in the present review. We applied qualitative thematic analysis to summarize the major results from these studies. RESULTS: Most of the HIAs (n = 31) reported the improvement of health or health behaviour resulting from an investigated project or policy. However, three HIAs reported a lack of improvement or even a decrease of health status. In parallel, 13 HIAs reported a gain in economic value, whereas one reported a lack or loss of economic effects. Moreover, three HIAs reported on social effects and six HIAs gave additional recommendations for policies or the implementation of projects or HIAs. CONCLUSIONS: Most HIAs investigate the impact of increasing active or public transport. Other features of walkability are less well studied. With few exceptions, HIAs document beneficial impacts of improving walkability on a variety of health outcomes, including reductions of mortality and non-communicable diseases.

The role of ecotoxicology in the health impact assessment: an innovative ecosystem approach for the protection of human health in Italy.

BACKGROUND: The Health Impact Assessment (HIA) is a procedure with the aim to protect the populations exposed to the impacts deriving from the establishment or upgrading of large industrial enterprises, i.e. large combustion plants (>300 MWth). In Italy a guideline for the HIA procedure has been published in compliance with the 2014/52/EU Directive on the Environmental Impact Assessment (EIA) requirements. Italian HIA procedure. An ecotoxicological approach has been included for the first time in the HIA procedure with the aim to detect toxic effects caused by unknown not-monitored contaminants or mixtures in the ecosystem components affected by the potential emissions, discharges and releases of large industrial enterprises. Ecotoxicology plays an important bridge role between environment and human health in the scoping and monitoring step of the HIA procedure with a key function of early warning system and screening. The aim of this paper is to present the Italian experience in the first three years of the application of the new approach, proposing recommendations on specific case studies. Conclusion and future perspective. 80% of enterprises, that applied HIA, have delivered a robust, integrated and detailed documentation in relation to the ecotoxicological assessment, this positive feedback will generate environmental and human health benefits to the areas where the plants are established.

Implementation of Health Impact Assessment in the Healthcare System of the Republic of Kazakhstan.

The Health Impact Assessment (hereinafter referred to as HIA) is an effective method for predicting potential health impacts from decisions. Little is known about the implementation of the HIA in the Republic of Kazakhstan (further, RK). In addition, the Russian language literature has not yet been reviewed in terms of HIA-related knowledge. By conducting a literature review of enabling factors, including Russian language literature, on the implementation of the HIA and studying governance systems in RK, we aim to suggest an implementation process to implement the HIA in RK. After careful analysis of the governance system, we suggest set up of a HIA support unit under the National Scientific Center for Health Development and discuss the possible benefits. The proposed center should guide the implementation of the HIA in RK.

Health impact assessment of local policies: methodology and tools.

The aim of this work was to design some tools and a procedure for performing the Health Impact Assessment of municipal policies. A working group made up of municipal and public health specialists from the Valencian Community (Spain) was set up. After reviewing the tools used in other contexts, the Fem Salut? questionnaire for the simplified Health Impact Assessment of regional policies was adapted for use at the local level. A pilot study was carried out in six municipalities and local initiatives promoted by different sectors were analysed. Two workshops were held per municipality (with specialists and with citizens) and participatory techniques were used to identify the possible impacts on the social determinants of health, the population groups more particularly affected and the proposals for improvement. The feasibility of the methodology and the difficulties involved in carrying it out were discussed. A procedure was defined for the Health Impact Assessment of local initiatives in six steps: Describe (the municipality and the project), Extract (screening phase), Co-produce (participatory workshops), Integrate (the scientific evidence with the qualitative information obtained), Disseminate (to politicians, specialists and community) and Evaluate (direct and indirect results) (DECIDE). A guide was developed to facilitate its application at the local level along with two complementary tools (a questionnaire and worksheets). The technical group rated the process as simple and flexible, as well as being easy to adapt to the characteristics of the municipality and project. In addition to the cross-sectoral approach, the incorporation of citizen participation in the process is an important added value.

Health impact assessment should be based on correct methods.

The methodology of health impact assessment (HIA), originally proposed by WHO, is widely used to predict the potential health effects in a community living in a place in which a new project (e.g., an industrial plant) will be implemented. One of the key quantities to calculate the impact (i.e., the number of attributable cases) is the baseline (i.e., before the project implementation) rate of selected diseases in the community. In a recent paper on this journal, this methodology has been challenged. Specifically, the use of baseline rate has been questioned, proposing to use only the fraction of the baseline rate due to the exposures related to the project, and not the rate due to all risk factors for the disease. In this commentary, we argue that the proposal is logically and epidemiologically unsound, and devoid of scientific motivation. The conclusion that the traditional approach overestimates the health impact should be rejected as based on flawed assumptions. On the contrary, the proposal may produce a (seriously biased) underestimation of attributable cases.

Health Impact Assessment: A Missed Opportunity for MCH Professionals in Their Quest to Address the Social Determinants of Health.

INTRODUCTION: Public health professionals, especially ones concerned with maternal and child health (MCH), need to engage in cross-sector collaborations to address social determinants of health. Health Impact Assessment (HIA) systematically brings public health perspectives into non-health decision-making contexts that influence social determinants. Alignment of MCH and HIA practice has not previously been documented. METHODS: An exploratory review of HIAs conducted in the United States considered several dimensions of MCH-HIA alignment and produced data to test the hypothesis that HIAs involving MCH stakeholders are more likely to address MCH populations and relevant measures. The review examined three key variables for each HIA: inclusion of MCH-focused stakeholders, level of focus on MCH populations, and presence of MCH-relevant content. RESULTS: Of the 424 HIAs included in the database of US HIAs, 350 were included in this review. Twenty-four percent (84) included MCH-focused stakeholders, and 42% (148) focused on MCH populations. Ninety percent (317) included metrics or content relevant to at least one Title V National Performance Measure (NPM). HIAs that clearly included MCH stakeholders had seven times the odds of including both a focus on MCH populations and at least one NPM-relevant topic compared to HIAs that did not clearly include MCH stakeholders (OR 6.98; 95% CI 3.99, 12.20). DISCUSSION: Despite low engagement of MCH stakeholders in HIAs, many still consider MCH populations and measures. Intentional engagement of MCH workforce in HIAs could ensure greater alignment with existing MCH priorities (such as addressing the social determinants of health and equity) in a given jurisdiction.

The Built Environment and Health in Low- and Middle-Income Countries: a Review on Quantitative Health Impact Assessments.

PURPOSE OF REVIEW: Features and attributes of the built environment (BE) impact positively and negatively on health, especially in cities facing unprecedented urban population growth and mass motorization. A common approach to assess the health impacts of built environment is health impact assessment (HIA), but it is rarely used in low- and middle-income countries (LMICs) where urbanization rates are fastest. This article reviews selected HIA case studies from LMICs and reports the methods and tools used to support further implementation of quantitative HIAs in cities of LMICs. RECENT FINDINGS: In total, 24 studies were reviewed across Algeria, Brazil, China, India, Iran, Kenya, Thailand, Turkey, and Mauritius. HIAs examine specific pathways through which the built environment acts: air pollution, noise, physical activity, and traffic injury. Few HIAs of BE addressed more than one exposure pathway at a time, and most studies focused on air pollution across the sectors of transport and energy. A wide number of tools were used to conduct exposure assessment, and different models were applied to assess health impacts of different exposures. Those HIAs rely on availability of local concentration data and often use models that have set exposure-response functions (ERFs). ERFs were not adapted to local populations except for HIAs conducted in China. HIAs of BE are being successfully conducted in LMICs with a variety of tools and datasets. Scaling and expanding quantitative health impact modeling in LMICs will require further study on data availability, adapted models/tools, low technical capacity, and low policy demand for evidence from modeling studies. As case studies with successful use of evidence from modeling emerge, the uptake of health impact modeling of BE is likely to increase in favor of people and planet.

Evaluation of human exposure to parabens in north eastern Poland through hair sample analysis.

Parabens (PBs) are a group of substances commonly used in industry. They also pollute the environment, penetrate into living organisms and adversely affect various internal organs. During this study, the degree of exposure of people living in Olsztyn, a city in north eastern Poland, to selected parabens most often used in industry was studied. The chemicals under investigation included: methyl paraben-MePB, ethyl paraben-EtPB, propyl paraben-PrPB, benzyl paraben BePB and butyl paraben -BuPB. To this aim, hair samples collected from the scalps of 30 volunteers were analyzed using a liquid chromatography-mass spectrometry technique. All PBs studied were present in a high percentage of analyzed samples (from 76.7% in the case of BePB to 100% in the case of MePB and PrPB). The mean concentration levels were 4425.3 pg/mg for MeBP, 704.0 pg/mg for EtPB, 825.7 pg/mg for PrPB, 135.2 pg/mg for BePB and 154.5 pg/mg for BuPB. Significant differences in PB concentration levels between particular persons were visible. On the other hand, gender, age and artificial hair coloring did not cause statistically significant differences in PB levels. Obtained results have clearly indicated that people living in north eastern Poland are exposed to various PBs, and therefore these substances may affect their health status. However, the evaluation of PBs influence on human health requires further research.

Using dynamic time warping self-organizing maps to characterize diurnal patterns in environmental exposures.

Advances in measurement technology are producing increasingly time-resolved environmental exposure data. We aim to gain new insights into exposures and their potential health impacts by moving beyond simple summary statistics (e.g., means, maxima) to characterize more detailed features of high-frequency time series data. This study proposes a novel variant of the Self-Organizing Map (SOM) algorithm called Dynamic Time Warping Self-Organizing Map (DTW-SOM) for unsupervised pattern discovery in time series. This algorithm uses DTW, a similarity measure that optimally aligns interior patterns of sequential data, both as the similarity measure and training guide of the neural network. We applied DTW-SOM to a panel study monitoring indoor and outdoor residential temperature and particulate matter air pollution (PM2.5) for 10 patients with asthma from 7 households near Salt Lake City, UT; the patients were followed for up to 373 days each. Compared to previous SOM algorithms using timestamp alignment on time series data, the DTW-SOM algorithm produced fewer quantization errors and more detailed diurnal patterns. DTW-SOM identified the expected typical diurnal patterns in outdoor temperature which varied by season, as well diurnal patterns in PM2.5 which may be related to daily asthma outcomes. In summary, DTW-SOM is an innovative feature engineering method that can be applied to highly time-resolved environmental exposures assessed by sensors to identify typical diurnal (or hourly or monthly) patterns and provide new insights into the health effects of environmental exposures.

ICP-MS Determination of 23 Elements of Potential Health Concern in Liquids of e-Cigarettes. Method Development, Validation, and Application to 37 Real Samples.

The lack of interest in the determination of toxic elements in liquids for electronic cigarettes (e-liquids) has so far been reflected in the scarce number of accurate and validated analytical methods devoted to this aim. Since the strong matrix effects observed for e-liquids constitute an exciting analytical challenge, the main goal of this study was to develop and validate an ICP-MS method aimed to quantify 23 elements in 37 e-liquids of different flavors. Great attention has been paid to the critical phases of sample pre-treatment, as well as to the optimization of the ICP-MS conditions for each element and of the quantification. All samples exhibited a very low amount of the elements under investigation. Indeed, the sum of their average concentration was of ca. 0.6 mg kg-1. Toxic elements were always below a few tens of a µg per kg-1 and, very often, their amount was below the relevant quantification limits. Tobacco and tonic flavors showed the highest and the lowest concentration of elements, respectively. The most abundant elements came frequently from propylene glycol and vegetal glycerin, as confirmed by PCA. A proper choice of these substances could further decrease the elemental concentration in e-liquids, which are probably barely involved as potential sources of toxic elements inhaled by vapers.

COVID-19 vaccination in Sindh Province, Pakistan: A modelling study of health impact and cost-effectiveness.

BACKGROUND: Multiple Coronavirus Disease 2019 (COVID-19) vaccines appear to be safe and efficacious, but only high-income countries have the resources to procure sufficient vaccine doses for most of their eligible populations. The World Health Organization has published guidelines for vaccine prioritisation, but most vaccine impact projections have focused on high-income countries, and few incorporate economic considerations. To address this evidence gap, we projected the health and economic impact of different vaccination scenarios in Sindh Province, Pakistan (population: 48 million). METHODS AND FINDINGS: We fitted a compartmental transmission model to COVID-19 cases and deaths in Sindh from 30 April to 15 September 2020. We then projected cases, deaths, and hospitalisation outcomes over 10 years under different vaccine scenarios. Finally, we combined these projections with a detailed economic model to estimate incremental costs (from healthcare and partial societal perspectives), disability-adjusted life years (DALYs), and incremental cost-effectiveness ratio (ICER) for each scenario. We project that 1 year of vaccine distribution, at delivery rates consistent with COVAX projections, using an infection-blocking vaccine at $3/dose with 70% efficacy and 2.5-year duration of protection is likely to avert around 0.9 (95% credible interval (CrI): 0.9, 1.0) million cases, 10.1 (95% CrI: 10.1, 10.3) thousand deaths, and 70.1 (95% CrI: 69.9, 70.6) thousand DALYs, with an ICER of $27.9 per DALY averted from the health system perspective. Under a broad range of alternative scenarios, we find that initially prioritising the older (65+) population generally prevents more deaths. However, unprioritised distribution has almost the same cost-effectiveness when considering all outcomes, and both prioritised and unprioritised programmes can be cost-effective for low per-dose costs. High vaccine prices ($10/dose), however, may not be cost-effective, depending on the specifics of vaccine performance, distribution programme, and future pandemic trends. The principal drivers of the health outcomes are the fitted values for the overall transmission scaling parameter and disease natural history parameters from other studies, particularly age-specific probabilities of infection and symptomatic disease, as well as social contact rates. Other parameters are investigated in sensitivity analyses. This study is limited by model approximations, available data, and future uncertainty. Because the model is a single-population compartmental model, detailed impacts of nonpharmaceutical interventions (NPIs) such as household isolation cannot be practically represented or evaluated in combination with vaccine programmes. Similarly, the model cannot consider prioritising groups like healthcare or other essential workers. The model is only fitted to the reported case and death data, which are incomplete and not disaggregated by, e.g., age. Finally, because the future impact and implementation cost of NPIs are uncertain, how these would interact with vaccination remains an open question. CONCLUSIONS: COVID-19 vaccination can have a considerable health impact and is likely to be cost-effective if more optimistic vaccine scenarios apply. Preventing severe disease is an important contributor to this impact. However, the advantage of prioritising older, high-risk populations is smaller in generally younger populations. This reduction is especially true in populations with more past transmission, and if the vaccine is likely to further impede transmission rather than just disease. Those conditions are typical of many low- and middle-income countries.

Opportunities for Closing the Gap in HIV Diagnosis, Treatment, and Viral Load Suppression in Children in Malawi: Results From a 2015-2016 Population-based HIV Impact Assessment Survey.

BACKGROUND: Control of the pediatric HIV epidemic is hampered by gaps in diagnosis and linkage to effective treatment. The 2015-2016 Malawi Population-based HIV impact assessment data were analyzed to identify gaps in pediatric HIV diagnosis, treatment, and viral load suppression. METHODS: In half of the surveyed households, children ages ≥18 months to <15 years were tested using the national HIV rapid test algorithm. Children ≤18 months reactive by the initial rapid test underwent HIV total nucleic acid polymerase chain reaction confirmatory testing. Blood from HIV-positive children was tested for viral load (VL) and presence of antiretroviral drugs. HIV diagnosis and antiretroviral treatment (ART) use were defined using guardian-reporting or antiretroviral detection. RESULTS: Of the 6166 children tested, 99 were HIV-positive for a prevalence of 1.5% (95% confidence intervals [CI]: 1.1-1.9) and 8.0% (95% CI: 5.6-10.5) among HIV-exposed children. The prevalence of 1.5% was extrapolated to a national estimate of 119,501 (95% CI: 89,028-149,974) children living with HIV (CLHIV), of whom, 30.7% (95% CI: 20.3-41.1) were previously undiagnosed. Of the 69.3% diagnosed CLHIV, 86.1% (95% CI: 76.8-95.6) were on ART and 57.9% (95% CI: 41.4-74.4) of those on ART had suppressed VL (<1000 HIV RNA copies/mL). Among all CLHIV, irrespective of HIV diagnosis or ART use, 57.7% (95% CI: 45.0-70.5) had unsuppressed VL. CONCLUSIONS: Critical gaps in HIV diagnosis in children persist in Malawi. The large proportion of CLHIV with unsuppressed VL reflects gaps in diagnosis and need for more effective first- and second-line ART regimens and adherence interventions.

Urban transport infrastructure planning and the public interest: a public health perspective.

OBJECTIVE: Transport infrastructure impacts public health. WestConnex in Sydney, New South Wales (NSW), is Australia's largest and most expensive transport infrastructure project. Concerns about the motorway project resulted in a NSW parliamentary inquiry into the project's impacts. Submissions to the inquiry were analysed to investigate their emphasis on health impacts and the cost-benefit analysis underpinning the project's business case. STUDY TYPE: Quantitative content and qualitative thematic analysis. METHODS: There were 556 submissions made to the inquiry into the impact of the WestConnex project. The content of a random sample of 93 (20%) of the individual submissions was analysed to identify health concerns. A purposive sample of 81 submissions by named groups including political parties and organisations was analysed separately (15% of the total submissions). RESULTS: Most individual submissions (63%) mentioned at least one aspect of health. Air pollution and children's health were the most frequently mentioned health issues. In the purposive sample, most submissions (64%) concerned the cost-benefit analysis (CBA), including concerns that the health impacts were being underestimated and economic benefits overestimated in the CBA. CONCLUSIONS: This study on the WestConnex project demonstrates how health impacts require early consideration within business cases for urban infrastructure projects, and later during environmental impact assessment. Systems for communicating and involving the public in decision making need to be improved, alongside greater transparency in CBA early in the project planning cycle.

Almussafes evalúa los impactos en la salud de su plan de movilidad / Almussafes assesses the health impacts of its mobility plan

Buscar el bienestar de la población y la equidad en salud requiere actuar sobre los determinantes sociales de la salud (DSS). El enfoque de salud en todas las políticas es el más idóneo para ello, y la evaluación del impacto en salud, la técnica cada vez más extendida, como instrumento de ayuda en la toma de decisiones. El objetivo principal de este trabajo es hacer un análisis prospectivo del impacto que puede tener el Plan de Movilidad Urbana Sostenible de Almussafes en la salud y equidad en salud de su población. Para ello, se ha empleado la herramienta Fem Salut al nostre municipi? junto con técnicas participativas, poniendo en valor el papel tanto de profesionales y personal técnico municipal como de la propia ciudadanía. A partir del análisis de su discurso, y en base a la evidencia científica, se identificaron los principales impactos del Plan sobre los Determinantes Sociales de la Salud: disminución de la contaminación ambiental y acústica, incremento de los desplazamientos activos y del bienestar emocional, etc. También se recogieron recomendaciones de mejora para potenciar los impactos positivos y su distribución equitativa. La participación ciudadana es un elemento clave en la evaluación de impacto en salud (EIS) de las políticas no sanitarias, y el ámbito local ofrece una oportunidad única para incorporarla en el proceso de toma de decisiones. Con ello, es posible desarrollar políticas públicas saludables y equitativas

Seeking the well-being of the population and health equity requires acting on the social determinants of health. The Health in All Policies approach is the most suitable for this, and Health Impact Assessment is the increasingly widespread technique, as a tool to assist in decision-making. The main objective of this work is to perform a prospective analysis of the impact that the Sustainable Urban Mobility Plan of Almussafes can have on the health and health equity of its population. For this purpose, the tool Fem Salut al nostre municipi? has been used, together with participatory techniques, which highlights the role of both professionals and municipal technical staff, as well as the role of citizens themselves. From the analysis of its discourse, and based on scientific evidence, the most important impacts of the Plan on the social determinants of health were identified: decrease in environmental and noise pollution, increase in active mobility and emotional well-being, among others. Recommendations for improvement to enhance positive impacts and their equitable distribution were also collected. Community participation is a key element in HIA of non-health policies, and the local scope offers a unique opportunity to incorporate this into the decision-making process. With HIA, it is possible to carry out healthy and equitable public policies

The price of precision: trade-offs between usability and validity in the World Health Organization Health Economic Assessment Tool for walking and cycling.

OBJECTIVES: The widely used World Health Organization (WHO) Health Economic Assessment Tool (HEAT) for walking and cycling quantifies health impacts in terms of premature deaths avoided or caused as a result of changes in active transport. This article attempts to assess the effect of incorporating 'life-years' as an impact measure to increase the precision of the model and assess the effect on the tool's usability. STUDY DESIGN: This article is a methods paper, using simulation to estimate the effect of a methodological change to the HEAT 4.2 physical activity module. METHODS: We use the widely used WHO HEAT for walking and cycling as a case study. HEAT currently quantifies health impacts in terms of premature deaths avoided or caused as a result of changes in active transport. We assess the effect of incorporating "duration of life gained" as an impact measure to increase the precision of the model without substantially affecting usability or increasing data requirements. RESULTS: Compared with the existing tool (HEAT version 4.2), which values premature deaths avoided, estimates derived by valuing life-years gained are more sensitive to the age of the population affected by an intervention, with results for older and younger age groups being markedly different between the two methods. This is likely to improve the precision of the tool, especially where it is applied to interventions that affect age groups differentially. The life-years method requires additional background data (obtained and used in this analysis) and minimal additional user inputs; however, this may also make the tool harder to explain to users. CONCLUSIONS: Methodological improvements in the precision of widely used tools, such as the HEAT, may also inadvertently reduce their practical usability. It is therefore important to consider the overall impact on the tool's value to stakeholders and explore ways of mitigating potential reductions in usability.

The Impact of the COVID-19 Pandemic on Children's Health in Portugal: The Parental Perspective.

INTRODUCTION: The COVID-19 pandemic poses unprecedented challenges for healthcare services and has led to changes in the usage pattern of the pediatric population. We aimed to describe the impact of COVID-19 on children's health, wellbeing, and access to medical care in Portugal. MATERIAL AND METHODS: We conducted a cross-sectional study through an anonymous online survey via social media. The collected data refers to a period between the 16th of March and the 17th of May 2020. RESULTS: We obtained responses to the survey on 19 745 children. Of the previously scheduled outpatient consultations, 54.2% were postponed by healthcare institutions and 21.6% of planned vaccinations were missed. Parents expressed concerns regarding psychological, social, and physical consequences for their children due to the pandemic. DISCUSSION: The observed reduction of pediatric emergency department visits and the postponement of outpatient consultations and vaccine administrations are potentially harmful for non-COVID patients. The current pandemic and the imposed social distance might have an important negative impact on the mental health of children. CONCLUSION: Further studies are necessary to fully comprehend the outcomes of the decreased access to medical care, as well as the collateral damage for children beyond the clinical aspects of the pandemic. Defining strategies regarding the urge to vaccinate children and not postpone urgent evaluations should be a public health priority.

Introdução: A pandemia COVID-19 constitui um desafio sem precedentes para os serviços de saúde e conduziu a alterações no padrão de utilização dos recursos pela população pediátrica. Procurámos descrever o impacto da pandemia COVID-19 na saúde infantil e no acesso à saúde em Portugal. Material e Métodos: Realizámos um estudo retrospetivo, recolhendo dados através da aplicação de um inquérito anónimo online nas redes sociais. Os dados referem-se ao período entre 16 de março e 17 de maio de 2020. Resultados: Obtivemos respostas ao inquérito relativas a 19 745 crianças. Da análise às respostas, concluímos que 54,2% das consultas previamente agendadas foram adiadas pelas instituições de saúde e 21,6% das vacinações previstas não se realizaram. Os pais expressaram preocupação quanto às consequências psicológicas, sociais e físicas da pandemia nos seus filhos. Discussão: A reduzida utilização dos serviços de urgência pediátricos, bem como a não realização de consultas e vacinações previamente agendadas é potencialmente lesiva para os doentes não-COVID. A pandemia e o isolamento social imposto poderão causar um impacto negativo na saúde mental das crianças. Conclusão: Estudos adicionais são necessários para melhor compreender as consequências da diminuição do acesso à saúde, bem como os efeitos psicológicos, sociais e físicos nas crianças. A definição de estratégias para incentivar a vacinação e o não adiamento de avaliações médicas urgentes deveriam ser prioridades de Saúde Pública.