Abstract
The present paper examines the historical evolution of health impact assessments as part of the environmental assessment process. The development of a coherent public health framework must be based on the model of determinants of health, integrating toxic and infectious risks and social impacts of projects. The integration of common concepts, processes and methodologies from the area of public health and social impact assessment challenges the quantitative model approach to risk assessment. The expert-driven risk assessment is transformed into a social learning process where local knowledge and scientific input foster a dialogue among stakeholders. The issue-oriented, iterative and participative assessment process may be applied to the health impact assessment of public policies. Sustainable development with its social objectives of empowerment, participation, equity, poverty alleviation, social cohesion, population stability and institutional development is an appropriate framework for conducting health impact assessments.
Abrégé
Dans cet article, on examine l’évolution des études d’impact sur la santé dans le cadre des procédures d’évaluations environnementales. Le développement d’un cadre cohérent de santé publique doit reposer sur le modèle des déterminants de la santé et intégrer les risques sociaux et infectieux ainsi que les incidences sociales des projets. L’intégration de concepts, de procédés et de méthodologies couramment utilisés en matière de santé publique et d’évaluation des incidences sociales remet en cause le modèle quantitatif pour évaluer les risques. L’évaluation des risques faite par des experts se transforme en un processus d’apprentissage social selon lequel les connaissances locales et l’apport scientifique favorisent le dialogue entre les individus concernés. Le processus d’évaluation itératif et participatif, axé sur les enjeux, peut être appliqué aux études d’impact sur la santé concernant les politiques publiques. Le développement durable, avec ses objectifs d’autonomisation, de participation, d’équité, de réduction de la pauvreté, de cohésion sociale, de stabilité démographique et de développement institutionnel est un cadre qui convient à la réalisation d’études d’impact sur la santé.
Footnotes
The section on public health in environmental assessments and the section on prediction, social learning and sustainable development are based on unpublished work which the author has done as part of a contract from the Office for Environmental Health Assessments, Health Canada to the Comité de santé environnementale du Québec.
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