توجه به بهداشت و درمان در ارزیابی زیست محیطی استراتژیک (SEA)

Following the requirements of the European Directive 2001/42/EC on strategic environmental assessment (SEA) and the Protocol on Strategic Environmental Assessment (Kiev, 2003) to the Convention on Environmental Impact Assessment in a Transboundary Context (Espoo, 1991), health is one of the aspects to be considered in SEA. In this paper, results of an evaluation of eight SEAs from Austria, the Czech Republic, Germany, the Netherlands and the United Kingdom (England and Wales) regarding the consideration of health are presented. This includes SEAs for five spatial plans, as well as one SEA for each, a transport, a waste management and an economic development plan. It is found that while all SEAs cover important physical and natural aspects that are related to health, social and behavioural aspects are considered to a much smaller extent. Based on the results, facilitating factors and barriers for health inclusive SEA are identified. Overall, good baseline data can be seen as an important starting point for effective health inclusive SEA, while an effective monitoring system is crucial for effective implementation of the measures and recommendations brought forward in health inclusive SEA. Crucially, health authorities/health experts need to engage more with SEA, as this provides a key platform for cross sectoral dialogue on a range of issues. SEA presents the health sector with an opportunity to influence the policy and decision-making process to improve people's health and well-being.

According to European Directive 42/EC/2001 on strategic environmental assessment (SEA), human health is one of the substantive aspects to be considered in SEA, next to biodiversity, fauna, flora, soil, water, air, climatic factors, material heritage (including architecture and archaeology), landscape, and the population. The interrelationship between the above factors is also to be considered. Similarly, the Protocol on Strategic Environmental Assessment to the Convention on Environmental Impact Assessment in a Transboundary Context (United Nations Economic Commission for Europe (UNECE) SEA Protocol) asks for the consideration of health. Once ratified, this will extend formal SEA requirements for health considerations to European Union (EU) and other countries. In this paper, the extent to which health aspects are considered in EU Directive based SEAs is discussed. This is based on an evaluation of existing SEAs, which was completed for the World Health Organization (WHO) who is supporting the application of health inclusive SEA. It is widely acknowledged that health is being affected by policies, plans and programmes that are implemented in all sectors. Therefore, the integration of the wider aspects of health into SEA provides the health sector with an opportunity to take on a stewardship role and gives considerable scope for action outside the health sector to prevent ill health and promote good health.

In this paper, eight EC-Directive-based SEAs from four sectors and five EU Member States were analysed. Four of these were local level plans and one each was prepared at the local regional (county) level, the regional level and the national level. All of them covered important physical and natural aspects that are related to health. However, only four also covered social and partly behavioural aspects to a substantial extent. In addition the consideration of these aspects in the actual assessment of options and impacts remained limited. Four of the eight SEAs had been mentioned either in the professional literature or by experts as examples of good practice. These were found to indeed include elements of good practice. However, weaknesses were also identified. These include e.g. an insufficient consideration of good baseline data in impact assessment or a quasi ex-post use of HIA only. Furthermore, while the four cases that represent ‘average’ practice were found to have a range of weaknesses – in particular a lack of appropriately addressing social and behavioural aspects – they also had strengths. These include e.g. the actual use of the baseline data in later impact assessment and the quantification of impacts. Strengths and weaknesses cannot be seen in isolation, but may, it appears, be partly explained by the overall context within which SEA is applied. Thus, discretionary planning appears to support – at least potentially – the consideration of various aspects that may go beyond those traditionally considered. While legalistic planning traditions appear to lead to a limitation of the factors for assessment to those legally required, they often appear to be used subsequently more consistently. Overall, facilitating factors for effective health inclusive SEA can be said to include: - the involvement of health professionals and stakeholders; - the clear distinction of assessment aspects that are likely to be of significance for anticipated options and impacts and those that are not; - the consideration of not only physical and natural factors; but also social and behavioural factors; always focusing on those that are relevant in a specific situation; - the use of SEA as an integrative instrument, aiming to achieve consistency of aims, objectives and proposed action of different decision tiers and sectors; - the coordination with other assessment tools if those are used; - the early application of assessment at a point when no decision on preferred aspects has been made, yet (proactive approach); - the release of specific guidance; - provisions for adequate guidelines; - institutional support by e.g. a dedicated body/commission. Barriers to health inclusive SEA include the absence of the factors mentioned above, plus institutional fragmentation. It is also important to stress that the problems outlined in the report, as well as the facilitating factors and barriers are not specific to health inclusive SEA. Similarly, these would apply to other factors and assessment instruments. What is clear from the analysis provided in this paper, is that health related factors are considered in EC Directive based SEA, but current practice suggests that some gaps remain towards achieving planning systems that can effectively deliver health inclusive SEA. SEA offers the opportunity to draw on the potential for health protection and promotion in environment and public health decisions. While many health determinants are directly affected by activities in other sectors, health sector actors do not appear to be always involved in these other sector decision-making processes often. Therefore, the legal provision for SEA, like the EU SEA Directive (2001/42/EC) and the UNECE SEA Protocol (UNECE, 2003) provide a key platform for cross-sectoral dialogue on a range of issues and present the health sector with an opportunity to influence the policy and decision-making process to improve people's health and well-being. Accordingly it is necessary that health authorities/health experts engage more and more in the SEA.