Health impact assessment should be based on correct methods

Main Article Content

Carla Ancona
Giorgio Assennato
Fabrizio Bianchi
Annibale Biggeri
Ennio Cadum
Dario Consonni
Francesco Forastiere
Andrea Ranzi

Keywords

Health impact assessment; epidemiology; public health

Abstract

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.

Abstract 406 | PDF Downloads 383

References

1. Zocchetti C. Epidemiologic health impact assessment: estimation of attributable cases and application to decision making. Med Lav. 2022;113(1):e-2022010. doi:10.23749/mdl.v113i1.12385
2. Lash TL, VanderWeele TJ, Haneuse S, Rothman KJ. Modern Epidemiology, 4th ed. Wolters Kluwer: Philadelphia, USA, 2021.
3. Cohen AJ, Anderson, HR, Ostro B, Pandey KD, et al. Chapter 17. Urban air pollution. In Ezzati M, Lopez AD, Rodgers A, Murray CJL (eds): Comparative quantification of health risks: global and regional burden of disease due to selected major risk factors. Volume 1. World Health Organization: Geneva, Switzerland, 2004.
4. Kuenzli N, Kaiser R, Medina S, Studnicka M, et al. Public-health impact of outdoor and traffic-related air pollution: a European assessment. Lancet. 2000;356(9232):795-801. doi: 10.1016/S0140-6736(00)02653-2
5. World Health Organization. Regional Office for Europe. Health risk assessment of air pollution: general principles. World Health Organization: Geneva, Switzerland, 2016. https://apps.who.int/iris/handle/10665/329677 (last accessed 14-02-2022)
6. World Health Organization. Regional Office for Europe. Health risks of air pollution in Europe – HRAPIE project. Recommendations for concentration–response functions for cost–benefit analysis of particulate matter, ozone and nitrogen dioxide. World Health Organization: Geneva, Switzerland, 2013. https://apps.who.int/iris/handle/10665/153692 (last accessed 14-02-2022)
7. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204-1222. doi:10.1016/S0140-6736(20)30925-9
8. European Environment Agency. Air quality in Europe 2021. https://www.eea.europa.eu/publications/air-quality-in-europe-2021/ (last accessed 14-02-2022)