Liveability as determinant of health: Testing a new approach for health impact assessment of major infrastructure

doi:10.1016/j.eiar.2020.106546

Environmental Impact Assessment Review

Volume 87, March 2021, 106546

https://doi.org/10.1016/j.eiar.2020.106546 Get rights and content

Highlights

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New infrastructure alters the human ecology, health is not explicitly considered.
•
Health impact assessment evaluates projects' impacts on health via determinants.
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An evidence-based, collectively exhaustive liveability framework is presented.
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The liveability framework is tested on HIA of level crossing removal in Australia.
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Liveability is useful for identifying pervasive yet subtle health impacts.

Abstract

Major urban infrastructure projects are intended to alter the built, human ecology for the better. Even when they are not labelled as health projects, arguably they should produce public health benefits that are commensurate with their scale, particularly when they are publicly funded. Health impact assessment (HIA) is an established method of evaluating major infrastructure projects using a determinants of health equity lens. HIA explicitly puts health front and centre to ask, ‘How should the proposed infrastructure project be altered to improve the determinants of health equity?’ There are well-established HIA protocols, but few provide a framework for scoping possible impacts. Given interest in the concept of liveability we introduce an exhaustive, evidence-based framework of 11 liveability domains for HIA. We then test the framework by scoping the impacts of the Upfield Level Crossing Removal (LXR) project in Melbourne, Australia to hypothesise its impacts on health. Scoping this case study suggests that many domains will be affected in complex ways, some positively and some negatively, exemplifying the potential for the framework to detect major infrastructures' pervasive impacts on determinants of health. The paper includes a plan to validate the liveability framework with empirical research in the HIA assessment stage. The paper concludes with a discussion of the contribution and usefulness of the liveability domains as a framework for structuring HIA and for building its profile, thus advancing the discipline, and helping to ensure that all major infrastructures constitute a prudent investment in public health.

Introduction

Like all species, humans are both a part, and a product of their ecology. For an ever-increasing proportion of society, the city has become the principle ecology (World Bank, 2017), and there is ample evidence that the quality of the built environment significantly affects health. The location and amount of public open space, opportunities for active transport, access to healthy food and other goods, opportunities for recreation, and proximity to centres of employment and education all show causal links to good health (Giles-Corti et al., 2016; Sallis et al., 2016).

Major infrastructures are the physical systems that provide services to the citizens of a state or nation. Infrastructure projects are usually provided by governments; funded through taxes, or by private-public partnerships. They include roads, rail, energy, water and broadband infrastructures. Investment in major infrastructure, particularly in the global south, can have diverse drivers, while the way public interests are treated is varied and complex (Mohan and Tan-Mullins, 2019; Searle and Legacy, 2020). All however, particularly those that are publicly funded, should contribute to equitable improvements in public health, commensurate with their scale (Nuffield Council of Biothics, 2007; Durrant, 2017). Arguably, government investment ‘upstream’ in health (Zola, 1970, cited in McKinlay, 2019) through improvements to the built environment is both an ethical responsibility and a prudent social investment. Investment in the determinants of health that make engaging in healthy behaviours the ‘easy option’ is generally more effective, equitable and yields more sustained benefits than does investing downstream in behaviour change (Watt, 2007).

This paper explores the feasibility of using an evidence-based social determinants of health (SDH) framework, Lowe et al., 2013, Lowe et al., 2015a liveability domains for health impact assessment (HIA) (Harris et al., 2007; EnHealth, 2017). The approach is tested by scoping the impacts of a major infrastructure project, the Upfield Level Crossing Removal (LXR) project in Melbourne, Australia, for later empirical examination. First, the paper introduces HIA protocols, Lowe's eleven liveability domains and the Upfield LXR case study. These are then brought together (Fig. 1), and the framework is tested by scoping the case study's impacts on determinants of health. The paper then describes a formal research program for testing the hypothesised impacts and thus validating the framework. The paper concludes with a discussion of the benefits of the framework for the wider HIA discipline.

The current paper therefore constitutes the first step towards testing Lowe et al., 2013, Lowe et al., 2015a eleven policy domains as a framework for comprehensive health impact assessments in the future, both in Australia and internationally. A forthcoming, comprehensive assessment of the case study will use the unique, liveability framework to ask, ‘Is LXR a prudent investment in public health?’

Section snippets

Health impact assessment

The understanding that health is socially determined has given rise to tools for evaluating proposed policies and projects using a ‘health lens’. Health Impact Assessment (HIA) is one of the predominant procedures and is embedded within other approaches such as Health in All Policies. Dannenberg et al., 2003, p.1506) state that an HIA is “an estimate of the effects of a specified action on the health of a defined population … to improve the quality of public policy decision-making from a health

A liveability framework for assessing determinants of health

In parallel to a growing understanding of the social determinants of health, liveability has arisen as an ideal for which cities should strive. Yet the definition of liveability is contested. The frequently-cited Economist Intelligence Unit's Liveability Index conceptualises international cities' liveability – including those in the global south – as a product of its good transport system, high proportions of public open space, low crime rates, and good educational opportunities (EIU, 2019).

Testing the liveability framework: The Upfield level crossing removal (LXR) project

In 2016, the state government of Victoria, Australia, as part of its ‘Big Build’ program (Victorian Government, 2020b), committed to removing 75 Melbourne metropolitan road/rail level crossings by 2025, “a faster rate of removal than in any other period of Melbourne's history” (Woodcock and Stone, 2016, p.13). Level crossing removal (LXR) involves either ‘undergrounding’ or elevating the railway to create ‘skyrail’. The two most frequently stated rationales for the Melbourne LXRs are to

The liveability domains applied to Upfield LXR

Drawing upon the literature, the following sections use the eleven liveability domains to scope Upfield LXR's impacts on health; short- and long-term, positive and negative. This provides a proof of concept for the liveability framework and a basis for a future detailed empirical examination of the impacts via data collection and analysis. This section is thus followed by proposed methods for gathering evidence in a future HIA assessment phase.

Framework for assessment phase of the HIA

Following on naturally from scoping, the liveability framework provides a useful structure for tackling the complex but essential empirical, i.e. assessment, phase of HIA. For Upfield LXR for example, examination of the eleven domains will involve four broad methods: literature reviews, primary research, secondary research and examination of comparable international case studies. For each domain, the literature review will establish the pathways and mechanisms that make each a determinant of

Discussion and conclusions

HIA aims to ensure consideration of the impacts of major infrastructure projects on health via social and other determinants. Despite this aim, to our knowledge no HIA has yet used an evidence-based and integrated liveability framework as a starting point for the scoping process, particularly not for a large built environment infrastructure project. As applied in this research, Lowe et al's., suite of liveability domains Lowe et al., 2013, Lowe et al., 2015b appears to be a collectively

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

Special thanks to Ms. Miranda Leckey who provided valuable advice during the preparation of this paper and to Dr. John Stone from Melbourne School of Design, The University of Melbourne, for support and advice. We also thank the four anonymous reviewers whose insightful comments contributed to substantial improvements in the manuscript.

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View full text

Liveability as determinant of health: Testing a new approach for health impact assessment of major infrastructure

Highlights

Abstract

Introduction

Section snippets

Health impact assessment

A liveability framework for assessing determinants of health

Testing the liveability framework: The Upfield level crossing removal (LXR) project

The liveability domains applied to Upfield LXR

Framework for assessment phase of the HIA

Discussion and conclusions

Declaration of Competing Interest

Acknowledgments

J. Clean. Prod.

Land Use Policy

Am. J. Prev. Med.

Am. J. Prev. Med.

Environ. Impact Assess. Rev.

Am. J. Prev. Med.

Lancet

Environ. Impact Assess. Rev.

Environ. Impact Assess. Rev.

Health Policy

Environ. Impact Assess. Rev.

Transp. Res. B Methodol.

Sci. Total Environ.

Cities

Health Place

Soc. Sci. Med.

Health Place

Transp. Policy

Sci. Total Environ.

Environ. Impact Assess. Rev.

Lancet

Landsc. Urban Plan.

2016 Census QuickStats

Biodiversity and human health: mechanisms and evidence of the positive health effects of diversity in nature and green spaces

Br. Med. Bull.

Serious Unintentional Injury Involving a Railway Train or Tram, Australia, 2009–10 to 2013–14. Injury Research and Statistics. Australian Government, Australian Institute of Health and Welfare

How Liveable Is Melbourne? Conceptualising and Testing Urban Liveability Indicators: Progress to Date

Exploring the bi-directional relationship between health and housing in Australia

Urban Policy Res.

Precarious employment: understanding an emerging social determinant of health

Annu. Rev. Public Health

Which has more trains? The Upfield line or the Geelong line?

A framework for integrated environmental health impact assessment of systemic risks

Environ. Health Perspect.

The case for ‘Environment in all Policies’: lessons from the health in all policies approach in public health

Environ. Health Perspect.

Cardinia Shire’s Liveability Plan 2017–29

Health impact assessment of transportation projects and policies: living up to aims of advancing population health and health equity?

Annu. Rev. Public Health

Crime and Community Safety

Patterns of receptive and creative cultural activities and their association with perceived health, anxiety, depression and satisfaction with life among adults: the HUNT study, Norway

J. Epidemiol. Community Health

Policies and Strategies to Promote Equity in Health

The impact of community design and land-use choices on public health: a scientific research agenda

Am. J. Public Health

Ministerial Guidelines for Assessment of Environmental Effects under the Environment Effects Act 1978. Department of Sustainability and Environment

Infrastructure, Equity and Urban Planning: A Just Process for the Allocation of Benefits and Burdens

The Global Liveability Index 2019. A free overveiw. Cabot Square, UK, The Economist

Risky Business – A Resource to Help Local Governments Manage Environmental Health Risks. Department of Health and Ageing

Health Impact Assessment Guidelines. Department of Health and Ageing

Relationship between urban sprawl and physical activity, obesity, and morbidity

Am. J. Health Promot.

Manchester named most liveable city in the UK - again

Health Impact Assessment in a Policy Context

Issue-Driven Problem Structuring. Cracked it!: How to Solve Big Problems and Sell Solutions like Top Strategy Consultants. B. Garrette, C. Phelps and O. Sibony

Moreland Post-Contact Aboriginal Heritage Study