ارزیابی زیست محیطی استراتژیک به عنوان کاتالیزور برنامه ریزی فضایی سالم : هدایت و عمل دانمارکی

A wide range of factors within spatial planning can affect health. There is therefore an important scope for Strategic Environmental Assessment (SEA) of spatial plans to protect and improve human health. Due to the EU Directive 2001/42/EC on SEA, health has been made explicit in Danish legislation and guidance. This paper examines the inclusion of health as a formal component in impact assessment of spatial plans. Based upon a documentary study of 100 environmental reports, the paper analyses and discusses how health impact considerations are incorporated in SEA practice. It is found that health impacts are included in SEA practice and are being interpreted in a broader sense than what the national guidance exemplifies. The frequent included health aspects are noise, drinking water, air pollution, recreation/outdoor life and traffic safety. The primary determinant for health is transport—whether it is at the overall or local planning level. The main conclusion is that SEA shows a potential to catalyse healthier spatial planning. Despite the broad inclusion of health in SEA practice the examination shows potential improvements, hereunder qualification of assessments by better explaining the nature and significance of impacts and by including the distributional aspects of human health impacts. Inclusion from the health sector is put forward as an important institutional mean to secure cross disciplinarily and higher quality assessment.

In a historical context human health has been one of the core elements in planning (Corburn, 2007, Rosen, 1993 and Duffy, 1990), for example tackling problems such as sanitation, air pollution, and light in urban areas. The experience with urban and spatial planning as a determinant for human health is long rooted and traces back to the 1800s documentation of mortality distributed differently due to different social and physical conditions (Rosen, 1993). Securing human health, especially in urban environments, is still today viewed as one of the major challenges for spatial planning and urban governance. One example of the present political and administrative focus is ‘the healthy cities' movement’ (International Healthy Cities Foundation, 2008), which in the WHO European Region now includes more than 1200 cities working with the linkages between public health and urban governance (WHO Regional Office for Europe, 2007 and De Leeuw, 2001). Land use and transport strategies affect air quality and noise; industrial waste can affect, both directly and indirectly, human health through the influence on e.g. water quality and land contamination; housing strategies affect access to adequate housing for all groups in society, and use of building materials influence physical health; mobility planning affects the choice of different transport modes such as walking and cycling and the access for people with impairments. These are a few examples of linkages and indicate that almost every planning decision potentially affects human health. However, today we find organisational structures in which a division of responsibility and foci exists. In a Danish context spatial planning is, in almost all cases, undertaken in technical departments with professionals such as planners, engineers and architects, who are not familiar with ‘determinants for health’ and other related terms. Health, on the other hand, is the responsibility of the health department, with other professions having the primary focus on providing service and treatment instead of prevention, and most likely rarely consider spatial planning, nor have heard of ‘Strategic Environmental Assessment’. This type of traditional government structure has met criticism for not being able to promote inter-sectoral and organisational integration in spatial planning to tackle complex, crosscutting issues like health (e.g. Harris and Hooper, 2004, Cowell and Martin, 2003 and Kidd, 2007). The experience with institutional barriers to the assessment of human health within EIA is analysed in a study across EU member states, and the experienced barriers are e.g. “Sectoral working and lack of multidisciplinary working and coordination between health and environmental professionals. Different and antagonistic perspectives between environmental and health experts need to strengthen the role of health experts within EIA” (Hilding-Rydevik et al., 2007). To solve the complexity of urban problems there is a need for a holistic and comprehensive approach to planning. However, the different levels and the horizontal division of governance make the necessary interaction in planning difficult. This professionalism and how it is part of creating specialised bureaucracies and thereby hinder the inclusion of health in spatial planning, is also underlined in the critical historical analysis of the connections, and disconnects between planning and public health in the U.S. (Corburn, 2007). Due to the experiences that removal and displacement of problems do not necessarily improve public health, Corburn (2007) points to precautionary and preventative strategies: “...the precautionary approach demands that preventive and protective actions should be taken even in the face of uncertain science and that the burden of proof of safety rests with those who create risks” (Corburn, 2007). To reconnect the two, Corburn suggests that the precautionary principle and a social justice frame should guide decision making and planning (2007). SEA is one example of a planning practice based upon the precautionary principle. SEA with a legal demand for a systematic and documented assessment, according to a broad concept of the environment including health, can be seen as a step in the direction of providing more comprehensive and healthier planning solutions in a divided planning system. The European political agenda has for more than two decades highlighted the necessity for including health issues in planning and decision making (WHO & Health Canada, 1986, WHO, 1997, Commission of the European Communities, 2004 and European Commission, 1994) and supports it by legal requirement, for example the EU Directive 2001/42 on the assessment of the effects of certain plans and programmes on the environment (SEA Directive), and provides practical guidance for how to do more comprehensive integration in planning (WHO, 1988, Barton and Tsourou, 2000, WHO, 2003, UNECE, 2007 and Aicher, 1998). The SEA Directive and the Protocol on SEA (UNECE, 2003) deals specifically with human health as a component of the assessment, and thereby stimulates the integration of health in planning and decision making above the project level. There is though a significant difference between the SEA Protocol and the SEA Directive regarding the requirements for the assessment of health impacts. The SEA Protocol accents health issues, while requiring consultation with the health authorities. This consultation requires likely capacity building for the spatial planning or environmental authorities (Stoeglehner and Wegerer, 2006). 1.1. Strategic Environmental Assessment and healthy planning The SEA directive covers plans and programmes “…prepared for agriculture, forestry, fisheries, energy, industry, transport, waste management, water management, telecommunications, tourism, town and country planning or land use and which set the framework for future development consent of projects…” (EU Commission, 2001). In the SEA Directive a broad concept of the environment is found covering aspects like biodiversity, population, human health, fauna, flora, soil, water, climatic factors, material assets etc. The same broadness is not found in the European EIA legislation which does not explicitly require human health to be assessed. Furthermore, despite international attention on health in EIA several studies have found that health is not sufficiently assessed and documented in EIA practice (Noble and Bronson, 2006, Steinemann, 2000 and Davies and Sadler, 1997). Instead of integrating health into the overall assessment of impacts, another approach is to assess health impacts in the separate Health Impact Assessment (HIA). HIA is an established approach and parallels the standard environmental assessment process with screening, scoping, impact prediction, mitigation etc. However, in a European context, HIA is only a recommended assessment. On the contrary SEA, with its legal basis, forms a stronger incitement for the inclusion of health impact considerations in planning (Birley et al., 1998). The EU Directive 2001/42 was implemented in Denmark in 2004 in an independent Act for all plans and programmes covered by the directive—Act No. 316 of 5th May 2004 (The Ministry of Environment, 2004). Since the implementation of the act, thousands of screenings have been undertaken and more than 100 environmental reports have been written. In 2006, a national guidance was published, and a ‘best practice guide’ with good examples was published in 2007. In both documents the broad concept of the environment, including human health, is emphasised as new and important for planning. The point of departure for the paper is the municipal practice regarding assessment of impact on human health in SEA of spatial planning: How and to what extent are health aspects included, assessed and documented? Whether the SEA is effective in integrating health in spatial planning is not to say based upon a study of the environmental reports only. The environmental report is the written product of the assessment, and the effectiveness of the SEA with respect to leading to better human health is not necessarily related to the content of the reports. To evaluate effectiveness, concerned with both the direct and indirect outcomes of the SEA, another research approach is needed (Thissen, 2000). The presented analysis, which concentrates on the health content of the assessment reports, can therefore not be used as a measure for effectiveness. Instead it shows how different criteria related to the content are performed in planning practice. The criteria are listed in the next section. Before presenting the analysis of practice, the paper will firstly present the Methodology and data, and secondly the inclusion of health in the national SEA Guidance.

The systematic and documented integration of human health aspects into European spatial planning has been a legal requirement since the introduction of EU Directive 2001/42/EC on SEA. The analysis of the Danish SEA guidance and the municipal SEA practice also shows that health is receiving more of a focus—both in guidance and in practice. The guidance, regarding assessment of impacts on human health: – underlines the importance of the broad concept of the environment, hereunder human health, – defines human health—though narrow compared to WHO definition, while it focuses on environmental variables only, – provides examples of objectives related to human health, and – recommends that the organisation of the SEA work must be cross disciplinarily to secure assessment of parameters within the broad environmental concept. The municipal practice, based upon the analysis of 100 environmental reports on the municipal plan and local plan level, shows e.g.: – Health as a parameter is included in planning and assessment practice (reports include in average 3.6 health aspects for municipal plans and 2.7 for local plans), and only 7 reports do not consider any health aspects at all. – Health is interpreted in a broader sense than the examples of health objectives provided in the guidance. 23 health aspects are found in total. – Aspects often included are: Noise, drinking water, air pollution, recreation/outdoor life and traffic safety. That counts for both municipal plans and local plans. For the less often and rarely/never included aspects, the same coherence between the two levels of assessments does not exist. – A comparison of length of reports and the number of health aspects shows a link: The longer the reports, the more aspects included. Another link that was found was that the involvement of consultants (either fully or partly preparing the report) results in longer reports. – Both negative and positive impacts on human health are assessed as required in legislation. Besides for golf courses, the environmental reports for all other planning themes show a dominance of negative impacts due to planning. – In more than 80% of the cases the assessment of human health is qualitative. – There is a lack of an assessment of the distribution of health impact; neither groups nor geographical areas are addressed. – The primary determinant for health at both planning levels is transport. – The presentation of human health impacts is lacking in the environmental reports, and it is very difficult to find the assessment of human health in the reports (only 7% of the reports treat human health under an independent heading). The above listed findings from SEA practice in spatial planning show that the authorities assess the impact on human health. The analysis, however, also points to methodological and institutional elements that can and should be improved in future practice. Regarding the assessments done, this needs to be qualified by explaining the nature and significance of the assessed health impacts and by including the distributional aspects of human health impacts. Furthermore the authorities need to treat human health as a separate element in the SEA and therefore present the assessment of impacts on health under its own heading in the environmental report. This will also ease the access for politicians and the public interested in health issues. The national guidance suggests a cross-disciplinary organisation of the SEA work. However, only one authority explicitly refers to the health department in the report. A conscious organisation of the SEA work, including representation from the health sector, is needed. Similar experience was found in a very recent study from England. Burns and Bond (2007) found in their communication with those involved in land use planning that SEA does provide a promising framework but lack of dialogue with health practitioners hinder the integration of health. Comparing the health determinants in the health map model by Barton and Grant (2006), the Danish SEA Guidance and the SEA practice, it is found that authorities take on board more determinants than only the physical ones indicated in the guidance—though significantly fewer than the health map model. The broadness of determinants assessed in SEA of spatial planning can be discussed. Knowing the discipline divided urban governance system, it seems unrealistic to include both physical and social determinants. In the re-integrating of spatial planning and human health, the negotiable way might be to first start with the physical determinants and secondly, when decided appropriately, consider social health determinants.