Last March 9, 2016, as part of the workshop organized by Health Care Without Harm-Asia entitled “Towards Healthy Energy Choices in the Philippines: Promoting the Use of Health Impact Assessments (HIA) for Energy Policies and Projects,” representatives from various stakeholder organizations engaged in a dynamic discussion about the future of HIA in the Philippines.

From L to R: Dr. Renzo Guinto (Healthy Energy Initiative); Dr. Beverly Lorraine Ho (Asian Development Bank); Engr. Regina Paula Eugenio (Department of Environment and Natural Resources); Engr. Bonifacio Magtibay (WHO-Philippines); Dr. Nasir Hassan (WHO-Western Pacific Regional Office); Dr. Joselito Gapas (First Philippine Holdings Corporation)

HIA refers to a combination of procedures, methods and tools to systematically evaluate the potential effects of a policy, program or project on the health of a population. Currently, the HIA is not widely utilized in the Philippines, as it is not yet institutionalized as a requirement for the approval and implementation of policies and projects in areas such as energy sector. HIA is one of the key recommendations of the Paris Platform for Healthy Energy, which is launched by Health Care Without Harm’s Healthy Energy Initiative last year.

State of HIA in the Philippines

“About 20 years ago, when the Environmental Impact Assessment (EIA) process was established, health was included,” said Engr. Bonifacio Magtibay, Technical Officer for Environmental Health of the World Health Organization (WHO) country office in the Philippines. “Eventually, the HIA work of the Department of Health (DOH) disappeared.”

This was reiterated by Engr. Regina Paula Eugenio of the Environmental Impact Assessment Division of the Department of Environment and Natural Resources (DENR). “DOH used to be invited in the EIA review team, but because of their internal restructuring, their participation stopped.”

However, Dr. Joselito Gapas, Environmental and Occupational Health Executive of the First Philippine Holdings Corporation, one of the Philippines’ leading investors in renewable energy, revealed the DOH’s plan to revive its work on HIAs.

“In cooperation with the WHO, the DOH recently developed the National Environmental Health Action Plan (NEHAP) for the period of 2016-2022. One of the targets of the plan is to incorporate HIA into all the other elements of the plan – air pollution, water supply, food safety, occupational health, etc.,” said Dr. Gapas, who also served as consultant for various DOH projects.

 Why HIA? 

“Why do you need an HIA in the first place? For decision-making? To delay investment? This ‘why’ must be explained by the country,” remarked Dr. Nasir Hassan, Regional Coordinator for Health and the Environment of the World Health Organization Regional Office for the Western Pacific. Emphasizing the importance of HIA, he mentioned that ‘a dusty HIA report will eventually surface 20 years later if there is any impact of that project on health.’ While traditionally, HIA has been applied in examining the health impacts of projects, it was also raised that policies and plans should be subjected to health assessments as well."

“WHO believes that HIA must be applied to both projects and policies, which have long-term impacts. This is in the spirit of the Health in All Policies (HiAP) approach,” added Dr. Hassan. Dr. Gapas brought to attention the reality on the ground. “To be honest, it is easy to look at projects because they are tangible. Environmentally critical projects or projects located in environmentally critical areas. However, I personally believe that it is policies where we should be most of the time. It’s more proactive and preventive.”

Developing a cadre of HIA practitioners

One of the challenges identified during the discussion is the lack of HIA practitioners in the Philippines. Dr. Gapas explained that “the problem is we do not have a system, a functioning system in the country that brings together our pool of resources, the academe, independent experts… we have many talented public health practitioners in the country.” He described how an effective HIA system might look like. “I have seen a system in a country where I would be reviewing an HIA for company X, but on the other hand I will be conducting an HIA for another project of company X. Trained HIA practitioners can both conduct and review HIA at different times.”

Dr. Beverly Lorraine Ho, consultant at the Asian Development Bank, noted the importance of strong policies to support capacity building. “As we have seen in countries in the Greater Mekong Subregion (GMS), there has to be incentive for professionals to go to this field. In Thailand, having a policy in place ensures that there is a pipeline of HIA experts.”

Dr. Gapas added that academic institutions such as the University of the Philippines College of Public Health cannot develop HIA courses if there is no system. “The rules of the game have to be set. Furthermore, there should be a clear career path after the training. You cannot encourage people to study HIA. It is difficult to talk about HIA with an empty stomach.”

Building the national HIA system

Having been working for WHO at the regional level, Dr. Hassan described the range of examples of how HIA is implemented in various Asian countries. “Korea does not have a separate HIA, but their EIA is so effective in itself. Similarly, Vietnam included health as part of the EIA system. On the other hand, Thailand’s Ministry of Public Health has its own HIA division.” Nonetheless, the first important step towards establishing a national HIA system is to identify champions within the health community. “Sadly, you get little support for HIA from the health sector itself. It is deemed very complicated. The health sector must believe in it first,” reminded Dr. Hassan.

Dr. Renzo Guinto, campaigner for the Healthy Energy Initiative of Health Care Without Harm-Asia and moderator of the panel discussion, summarized the key highlights of the conversation: “The ingredients for a successful HIA system – strong policies and institutions; a cadre of professionals not just from the health sector but from a wide range of disciplines who can perform, review, evaluate, defend, use HIA in the most meaningful way; the political support from leaders as well as demand from the people – all these are equally critical and important.”