Abstract
Place is more than physical and natural environment. The role of biophysical environment has still to be articulated in population health discourse and its relations with human health are fraught with scientific uncertainty and dissension. An environmental impact assessment (EA) evaluates the environmental effects of a proposal - a rational and technical process. Sometimes health assessments are included, usually by quantitative risk assessments which are subject to the limits of scientific knowledge and bedevilled by data limitations. The goal must be to add health to the process, yet the relevant features to include are complex. Impacts are non-specific and they interact and have spatial and temporal characteristics. To integrate environment into population health, there is a need for a physical environment-health database and intersectoral policy and action. There is also a need for different types of indicators to measure process, impact and effectiveness, and for new tools (stories, photography) to account for context and values.
Abrégé
Un endroit n’est pas seulement un environnement physique et naturel. Le rôle de l’environnement biophysique reste à définir dans le discours sur la santé de la population, et ses liens avec la santé humaine soulèvent beaucoup d’incertitudes scientifiques et d’opinions dissidentes. Les études d’impact sur l’environnement évaluent les répercussions d’un projet sur l’environnement - il s’agit d’un processus rationnel et technique. Il arrive que les évaluations sur la santé soient incluses, habituellement dans le cadre des évaluations quantitatives des risques qui sont limitées aux connaissances scientifiques et tronquées par les limitations des données. L’objectif doit être d’ajouter la santé au processus même si les caractéristiques qui intéressent sont complexes. Les impacts ne sont pas spécifiques; ils interagissent entre eux et possèdent des caractéristiques spatiales et temporelles. Pour intégrer l’environnement à la santé de la population, il nous faut disposer d’une base de données santé - environnement physique, avoir des politiques intersectorielles et agir. Nous avons également besoin de différents types d’indicateurs pour mesurer le processus, son impact et son efficacité, et nous devons également avoir de nouveaux outils (récits, photos) pour prendre en compte le contexte et les valeurs.
Footnotes
The author acknowledges Health Canada and the Institute of Health Promotion Research for assistance in attending the conference at which the paper was first presented.
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