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International audience; Health Impact Assessment (HIA), an inherently trans-disciplinary approach, is used to help evaluate and improve projects or programmes in sectors such as transportation, where new infrastructure is likely to have effects on health. This article describes the screening, scoping, appraisal, and recommendation steps of an HIA on a new 24 km highway around the conurbation of Strasbourg, France. Methods included a literature review and quantitative estimates of the health effects of air pollution and noise. Although planned, interviews and focus groups proved impossible due to political and administrative difficulties. In replacement, answers to a related public inquiry were submitted to a secondary, thematic analysis. The new infrastructure is likely to create or help maintain some jobs in the short term and might accelerate certain journeys, but it does not seem able to improve local mobility and air quality issues. It crystallises the dissatisfaction of a part of the local population and raises the question of the transparency of the design and validation processes of major infrastructure projects. Despite an unfavourable political context, the HIA approach described in this article was able to overcome methodological difficulties and obstacles thanks to creative research methods and trans-disciplinarity to finally yield relevant information and suggestions for urban health promotion.

Evaluation globale des Plans nationaux santé – environnement (2004 – 2019) – Synthèse du Rapport (HCSP, Avis et Rapports)Francelyne Marano, Daniel Bley, Muriel Andrieu-Semmel, Jean-Marc Brignon, Sara Brimo, Patrick Brochard, Rémy Collomp, Sébastien Denys, Alice Desbiolles, Hélène Desqueyroux, François Eisinger, Luc Ferrari, Éric Gaffet, Philippe Hartemann, Sabine Host, Philippe Hubert, Jean-Marie Januel, Joseph Kleinpeter, Agnès Lefranc, Laurent Madec, Charlotte Marchandise-Franquet, Laurence Payrastre, Kiran Ramgolam, Jean-Louis Roubaty, Michel Setbon, Jean Simos, Fabien Squinazi, Anne Vidy, Denis Zmirou-Navier, Dominique Maison, Soizic Urban-Boudjelab, Lottie FriedericiEditeur : Haut Conseil de Santé PubliqueVersion du 18 Mars 2022Mise en ligne le 20 Juin 2022 (36 Pages)https://www.hcsp.fr/Explore.cgi/AvisRapportsDomaine?clefr=1223https://www.hcsp.fr/Explore.cgi/Telecharger?NomFichier=hcsps20220318_valglodesplanatsanenv.pdfLe HCSP a réalisé l’évaluation des trois premières générations de plans nationaux santé environnement (PNSE) (2004 - 2019) et de leurs déclinaisons régionales sous la forme de plans régionaux santé environnement (PRSE).Quatre thématiques ont été retenues pour l’analyse :-Les polluants dans l’air extérieur : ceux du domaine réglementaire et les pollens.-L’environnement intérieur : qualité de l’air dans les écoles et les crèches, habitat dégradé, radon, légionellose.-Les risques dits émergents : nanomatériaux, ondes électromagnétiques, perturbateurs endocriniens.-Les produits chimiques et leurs usages : les produits chimiques dans les biens de consommation, dans l’alimentation, dans l’environnement aquatique. En complément, est intégré dans l’analyse le programme de biosurveillance.De plus, les thématiques transversales suivantes ont notamment été analysées : l’évolution de la perception du public des risques liés à l’environnement et les actions d’information et de formation menées à l’échelle nationale et régionale.L’évaluation réalisée par le HCSP, sans avoir pris en compte l’ensemble des actions des 3 plans, à travers les thématiques considérées, permet d’avoir une vision globale de l’évolution des politiques publiques en santé-environnement en France au cours des quinze dernières années et de tirer des conclusions générales sur les rôles que les PNSE et les PRSE ont joué dans ce domaine. Elle montre que la connaissance et la réduction des expositions ont été parmi les sujets majeurs développés depuis 2004 alors que les effets sanitaires restent encore souvent à évaluer. La déclinaison des actions au niveau des territoires a joué un rôle essentiel.À l’issue de cette analyse, le HCSP propose trois grandes catégories de recommandations :-des recommandations générales à l’échelle nationale qui portent sur la gouvernance, la recherche, le recueil de données et la formation en santé environnement ;-des recommandations spécifiques aux PRSE, outils qui s’avèrent indispensables dans la gestion territoriale ;-des recommandations relatives aux quatre thématiques abordées dans l’évaluation.Cette évaluation fait suite à une saisine de la Direction générale de la santé et de la Direction générale de la prévention des risques de 2020.Lire aussi dans les avis et rapports :-Protection des personnes contre le risque lié au radon dans les bâtiments du 17 mars 2010-Pollution par les particules dans l’air ambiant : recommandations pour protéger la santé du 13 avril 2012-Évaluation du 2e plan national santé environnement du 19 septembre 2013-Information et recommandations à diffuser en vue de prévenir les risques sanitaires liés aux pollens allergisants du 28 avril 2016-Rapport relatif aux indicateurs composites en santé-environnement du 28 janvier 2021

International audience; Afin de suivre l’état global de la santé liée à l’environnement, le HCSP recommande le développement d’indicateurs composites. Ces indicateurs composites agrègent des données d’origines différentes dans une valeur unique, et présentent l’avantage de permettre d’intégrer plusieurs dimensions de la santé-environnement qu’il s’agisse de la multiplicité des expositions ou de la multiplicité des effets sanitaires. Ils sont pertinents pour traduire des tendances (positives ou négatives) des impacts environnementaux et sanitaires, sans pour autant prétendre prédire de manière exacte les impacts des différents facteurs de risque dont ils sont composés. Ils facilitent l’appropriation de l’information et permettent également des comparaisons à différents niveaux d’échelle, de l’international au local. Le HCSP rappelle que les indicateurs composites ne remplacent pas les indicateurs de moyens ou de résultats associés aux actions du PNSE4.Le HCSP a examiné et recommande trois types indicateurs composites :-Indicateurs composites portant sur l’état de l’environnement et / ou sur les expositions environnementales.-Indicateurs composites portant sur l’état sanitaire et / ou de la santé en relation avec l’environnement.-Indicateurs de bien-être et qualité de vie.Le HCSP recommande, de diversifier les indicateurs à retenir, de manière à couvrir plusieurs réalités des enjeux de santé – environnement et de s’appuyer sur la complémentarité des différentes approches pour constituer un set d’indicateurs.Cette évaluation a été produite par le Haut Conseil de la santé publique (HCSP) suite à la saisine conjointe de la Direction générale de la santé (DGS) et de la Direction générale de la prévention des risques (DGPR) dans le cadre de l’élaboration du 4e Plan national Santé environnement (PNSE 4).Lire aussi dans les avis et rapports :Liste des indicateurs de résultats et d’impact de la stratégie nationale de santé 2018-2022 du 27 février 2019 (https://www.hcsp.fr/Explore.cgi/AvisRapportsDomaine?clefr=718)

International audience; Cet article interroge les effets des modalités partenariales de recherche du projet GREENH-City associant des chercheur.e.s au Réseau français des Villes-Santé OMS (RfVS). Il propose une analyse de l’appropriation des connaissances scientifiques liées au projet par les villes membres du RfVS à partir du modèle de partage de connaissances. L’article montre qu’un décalage temporel peut s’opérer entre la production et l’utilisation des données liées au projet et interroge les modalités de partage de connaissances comme les pratiques de cette recherche interventionnelle.

International audience; This scoping study aims to explore the relationships between urban green spaces (UGSs) and the onset, remission and recovery of cancer. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (protocol published in 2018). Eligibility criteria for papers were: (1) to be concerned with UGSs, (2) reporting effects of UGSs on cancer-related outcomes including direct or indirect measures, (3) reporting randomized controlled trials, prospective cohort studies, case studies, observational studies, non-comparative studies, (4) in English or French. The search covered primary studies in the published and unpublished (grey) literatures searching by hand and electronic databases (MEDLINE, Green File, Cumulative Index to Nursing and Allied Health Literature and ScienceDirect). Among 1703 records screened by two reviewers independently, 29 were included for qualitative synthesis. We classify the cancers concerned and the effects reported i.e., protective effect, risk or without association. The most investigated cancers are bladder, breast and lung cancer. Our study also identified contributing factors and their mediating effects between UGSs and cancer. Even though the strength of the evidence of the associations between UGSs and cancer is still weak due to the low number of studies and their design, results highlight the wide variety of possible mediating factors between the use of green spaces and cancer occurrence, remission and/or prevention. Knowledge gaps and future research perspectives should be oriented to qualitative research on protective factors with an attention to equity in UGS access and use.

AVERTISSEMENT : Ce document constitue une note intermédiaire portant sur le travail mené par le GT « indicateurs globalisés pour le PNSE 4 et évaluation des 3 PNSE » mis en place par le HCSP. Le contenu de ce document est strictement réservé aux membres du GT, ainsi qu’aux ministères ayant formulé la saisine et n’a pas vocation à être diffusé sous quelque forme que ce soit. Le document présente par ailleurs un point d’avancement de la réflexion menée par le groupe de travail et ne saurait présager de l’avis final qui sera exprimé par celui-ci.RésuméPar la saisine conjointe du 27 mai 2020, la Direction Générale de la Santé (DGS) et la Direction Générale de la Prévention des Risques (DGPR) ont sollicité le Haut Conseil de la Santé Publique (HCSP) afin de recueillir des propositions d’indicateurs globaux (de l’ordre de 5) pour le futur Plan National Santé Environnement (PNSE 4). Pour traiter cette saisine prise en charge par la commission spécialisée sur les risques environnementaux (CSRE), un Groupe de travail a été mis en place (30 experts internes et externes au HCSP) aidé par une AMO (Planète Publique) et une chargée de mission du secrétariat du HCSP (Annexe 2).La demande porte sur la proposition d’indicateurs composites peu nombreux, permettant à la fois un suivi de l’impact des politiques de santé environnementale, des comparaisons internationales et une communication publique. Ces indicateurs composites doivent être centrés sur l’évaluation de l’évolution des expositions environnementales et leurs impacts sanitaires en complément des indicateurs de moyens et/ ou de résultats qui seront établis pour chaque action et axe du PNSE 4.Dans le champ de la santé environnementale, ces indicateurs composites ou globaux, qui agrègent des données d’origines différentes dans une valeur unique, présentent l’avantage de permettre d’intégrer plusieurs dimensions de la santé-environnement qu’il s’agisse de la multiplicité des expositions ou de la multiplicité des effets sanitaires.1. Ils traduisent de manière simple des situations complexes, ils facilitent l’appropriation de l’information.a. Ils peuvent aider les décideurs (locaux, régionaux ou nationaux) dans la prise de décision et la priorisation des actions à mener (thématiques, territoires, populations…)b. Ils facilitent la mise en visibilité des résultats obtenus, des progrès réalisés par exemple dans un exercice de communication et en particulier auprès du grand public.2. A l’inverse, ils peuvent donner lieu à une interprétation simpliste de ce qu’ils permettent de mesurer et doivent faire l’objet de certaines précautions dans leur utilisation, en particulier au regard des questions méthodologiques qu’ils posent et de l’inégale disponibilité des données pour les différentes dimensions qui les composent.3. Par la lourdeur de calcul qu’ils impliquent (démultipliée par le nombre de variables individuelles qu’ils agrègent), ils sont peu propices à une actualisation régulière. Dans ces conditions, leur utilisation peut difficilement s’envisager selon des pas de temps rapprochés, qu’il s’agisse du pilotage de l’action publique ou de la communication / valorisation des résultats obtenus.4. Parce qu’ils intègrent différentes dimensions, ils peuvent rendre difficile l’attribution de la causalité d’une évolution à une action précise (justifier que l’évolution de l’indicateur est bien liée à l’effet du plan).Cette note fait état des travaux actuels du GT à la suite des auditions et du bilan des recherchessur le développement d’indicateurs composites en santé et environnement en France et à l’étranger. Elle sera complétée et des recommandations seront faites pour une publication du rapport en février 2021. Dans l’état actuel de ses réflexions, le Groupe de travail a sélectionné trois types indicateurs composites qui peuvent répondre aux demandes des commanditaires DGS et DGPR.

Greece is a European-Union country, of around 10 million people, located in the southeast part of Europe. The economy is recovering from a long period of deep recession, due to the economic crisis that started in 2008. The economic problems greatly influenced the structure and resources of the healthcare system of the country. In addition to the economic challenges, the country has been facing a refugee crisis, characterized by many overcrowded hotspots and tensions with neighboring Turkey. The COVID-19 outbreak arrived in Greece on 26 February 2020, at the time that Athens had declared a state of emergency at the Greek/Turkish border. From this point in time the government enforced a series of measurements, aiming to contain the epidemic and avoid the collapse of the healthcare system. The vast majority of the general population complied to the measures and consequently Greece’s death toll was low. The impacts of the outbreak are expected to be, as everywhere worldwide, multifaceted and to affect many parts of the economic, social and political life of the country.

International audience

Issue In 2018-2019, HIA was carried out on a projected 24-km north-south motorway bypass in a rural area west of Strasbourg, intended to alleviate pressure on a pre-existing motorway that cuts through the city centre. Although transport is a major source of impacts on health, HIA is rarely performed on new road construction projects, globally. Description The HIA included the screening, scoping, assessment and recommendations phases. Assessed health determinants were outdoor air quality, noise, mobility/access to health services, road safety, urban planning and the living environment. Methods included a literature review, the AirQ+ air pollution model, cartography and an NVivo analysis of answers to a public enquiry. Results Noise was set to increase for 1-4% of the population in the study area, but impacts related to air pollution appeared to be negligible and road safety did not change substantially. Mobility and access to health services were to improve, with strong local differences (inequalities): some areas benefitted from access to the new motorway without being affected by noise or traffic, while for others it was the opposite. Stakeholders who participated in the public enquiry were concerned about the loss of agriculturally and environmentally valuable land, viewed as a collective cultural asset. Those living in the vicinity of the bypass expressed anger at the reduction of the quantity and quality of green areas, which was experienced as an injustice given their choice to live in a rural area. Our recommendations related mainly to the pre-existing urban motorway, where reducing traffic volumes and speeds, as well as diverting trucks onto the new bypass, had the most promising effects on health. Lessons Due to its rural localization, the new road had limited health effects through air pollution, which is the focus of many transport-related HIAs. Through the analysis of the public enquiry, the HIA showed that the project generated anger and distress. Key messages The substantial investment represented by the new bypass did not solve pre-existing problems related to environmental health but generated new ones linked to social and mental health issues. Many HIAs miss out on valuable qualitative information because interviews or focus groups cannot be carried out with local stakeholders. Secondary analysis of public consultations can fill this gap.

Since the early 1980s we have witnessed a proliferation of 'Theme Cities' with the WHO 'Healthy Cities' networks a very early adopter, together with local government initiatives that focused on environmental health and sustainability. These days such networks range very broadly, from Citta Slow and Child-Friendly Cities to sustainable, resilient, festival, happy, garden, winter, safe, inclusive and many more theme-centered international networks of local governments and communities. We undertook a political analysis of the extent to which these networks formally recognise and address the drivers of inequity in societies around the world, and to which extent they are ready to act truly glocally. We found that 'Sustainable Cities' rank highly, with WHO/EURO and PAHO style 'Healthy Cities' a close second. 'Transition Towns and Communities' are in a category of their own and can be considered a potentially important political voice for glocal health equity. Key messages Healthy Cities are Theme Cities - but not all do well to promote health equity. Sustainability and health (as per the SDGs) have enormous glocal health potential.

Health impact assessment as a public health tool to contribute to development of healthy public policy and later health in all policies approach entered public health practice, research, education and policy at the end of 1990'. During last 20 years the methodology spread around the globe, tools and guidelines have been developed, potential collaboration with other impact assessments discussed or even legally mandated. A quick search in PubMed using a MESH keyword “Health impact assessment” conducted in January 21, 2020 yielded 628 publications in time period of 2010-2019. Reading the abstract of last 100 from 2019 and partially 2018 based on first authors, manuscripts came from 31 countries of all five continents, USA being the most frequent contributor. This quick search revealed also substantial heterogeneity of the use of term; epidemiological studies, often environmental epidemiological ones, health care intervention evaluation studies, methodological development studies, general evaluation studies are often using health impact assessment label. Out of 100 abstracts, 14 seemed to be in-line with description of HIA by Gothenburg consensus paper, the basic document of HIA. On one hand, this is very positive showing the wide possibilities of use of HIA. On other hand however, it is hazardous as it could lead to misunderstandings and consequently to decreased interest for the methodology. With this regard it shall be noted that after a plateau in number of publications between 2014-2017, there seems to be a consistent decline of new research papers addressing using HIA. Looking at one database only can be a limitation of course. The aim of this round table workshop is to discuss where to go with HIA during coming years, identify potential facilitators for broader implementation and use of the methodology. After introductory presentation by workshop coordinators, five presentations will discuss potential facilitators such as common language and expectations, implementation and place of HIA within public health toolkit, capacity building and recent opportunities such as health in EIA and the SDG's. The final part of the round table will be as general discussion with involvement of the audience facilitated by workshop organizer. Key messages HIA is used for different purposes, not only the one described by Gothenburg consensus paper. There is a substantial heterogeneity in use of HIA influenced by language, implementation method, available capacities and motivation.

Introduction Action on the determinants of health and equity involves the participation of all sectors, including non-health sectors. Understanding the opportunities and constraints to engage in the complex issue of health inequalities requires opening the black box of policy making. It also requires close interaction between field actors and researchers. This paper will aim to analyze the modalities of collaboration between researchers and field actors in the service of knowledge sharing, within the GREENH-City project. Methods The GREENH-City project was built in an interdisciplinary and intersectoral manner and involves close collaboration with the WHO French Healthy Cities Network (FHCN). Its objective is to characterize the most promising health interventions in all policies at the city level to promote equity through green space policies. Based on the knowledge sharing model and the theory of diffusion of innovations, we will analyze how this research allows initiating collaborations between the different municipal sectors on health issues. Results The intervention nature of the project seems to help the dissemination of collaborations, particularly between health services and green space services within the cities of the FHCN. The analysis, using theoretical models, of the body of empirical data collected from cities will make it possible to identify the levers and collateral effects activated by the research project. Discussion The GREENH-City project was built on the basis of an interventional research framework. This choice was made precisely because of the interaction it induces between researchers and practice environments. Initial empirical results suggest that it promotes the dissemination of knowledge, a necessary first step in the evolution of practices. Indeed, the effective appropriation of research results can only be assessed in the long term and must take into account the contextual elements specific to each FHCN involved in the research. Key messages Implementation of interventional research helps to engage fields collaborations. Health in all policies may be supported by a research project at the local level.

The new One Health approach proposes to view the human-animal-ecosystems relations as a continuum. This systemic approach proves very valuable when examining the links between wooded green spaces in urban areas and the health of city dwellers (more than half of the world population). These links and their diversity and complexity are now beginning to be adequately documented by the scientific literature. Some benefits and risks for human health can now be better analysed enabling areas for useful action in the future to be identified.

National audience; En France, les inéquités de santé tendent à augmenter depuis les années 80.De nombreuses études concernent l’influence des déterminants sociaux, économiques, géographiques ou politiques dans une approche tout au long de la vie.Les expositions aux facteurs environnementaux sont inéquitables au sein de la population.L’environnement peut être un facteur protecteur, tels que sont les espaces verts en milieu urbain.En milieu urbain, les espaces verts contribuent à créer des milieux de vie favorables à la santé qui peuvent impacter les inéquités de santé.Les approches de santé dans toutes les politiques (HiAP) sont l’une des stratégies clés pour prendre en compte les déterminants sociaux et environnementaux et créer des milieux urbains favorables à la santé. (Extrait)

Introduction Espace du quotidien, de détente et de récréation, lieu de promenade, de rencontre et de pratiques sportives, l'espace vert est vecteur de bien-être et de santé. Au regard des multiples bénéfices potentiels que représente l'exposition des populations aux espaces verts urbains et des problématiques contemporaines de santé, l'accessibilité de tous à ces lieux constitue un enjeu majeur de santé publique. Le projet de recherche GREENH-City (Inca RI 2017-03) propose, parmi les communes du Réseau Français des Villes Santé de l'OMS, d'analyser en quelle mesure les politiques municipales intègrent des démarches de santé dans toutes les politiques, de promotion de l'équité et les appliquent aux politiques de verdissement. L'objectif de cette communication est d'examiner les enjeux théoriques et méthodologiques de l'analyse socio-spatiale des espaces verts urbains dans le contexte français afin, notamment, d'objectiver l'accessibilité de tous aux espaces verts, quels que soient les territoires de vie ou les situations socio-économiques des populations. Méthode Les données municipales, nationales (Institut national de l'information géographique et forestière) et internationales (« Open Street Map ») disponibles pour appréhender les espaces verts, ainsi que des indicateurs socio-économiques (Institut national de la statistique et des études économiques) permettent en effet d'appréhender les surfaces et types d'espaces verts disponibles, des distances d'accès moyens des ménages aux espaces verts, et ce, au regard des disparités socio-économiques infra-urbaines en présence. Par exemple, les espaces verts d'une ville peuvent s'avérer beaucoup plus accessibles à une partie de la population (accessibilité pédestre très aisée) et cette même population peut disposer d'une surface moyenne par habitant très restreinte. Une analyse comparative et multiscalaire permet d'illustrer la diversité des situations. En effet, l'ampleur des écarts entre classes sociales ou entre quartiers dépend des contextes urbains considérés. De telles analyses permettent d'interroger la démarche, les échelles et les outils de mesure à mobiliser lorsque l'on interroge l'équité et l'accessibilité aux espaces verts urbains. Des analyses qualitatives des usages et des pratiques de ces espaces par les individus devront également compléter cette approche. En effet, un espace potentiellement disponible n'est pas forcément approprié, utilisé de façon optimale. En mobilisant une approche mixte et comparative, la recherche développée dans le cadre du projet GREENH-City permettra d'apporter des réponses à cet enjeu majeur.

Le présent rapport constitue une première réponse à la saisine relative à l’habitat favorable à la santé adressée par la Direction générale de la santé le 21 avril 2018 au Haut Conseil de la santé publique. Ce rapport constitue un document de référence identifiant les propriétés de l’habitat ayant un impact sur la santé. Une description de l’ensemble des facteurs influençant positivement ou négativement la santé a été réalisée, selon différentes dimensions : l’environnement extérieur proche du logement, caractéristiques du bâti et des occupants incluant leurs comportements. Pour chaque dimension, les sources documentaires les plus pertinentes ont été référencées, sans prétention d’exhaustivité, ainsi que les réglementations applicables et les recommandations d’usage ou d’entretien. Les facteurs identifiés sont pour la plupart du temps interconnectés et les effets sur la santé des occupants résultent de leurs actions combinées. Les risques « émergents » de type nanomatériaux, ondes électromagnétiques, perturbateurs endocriniens ou bien objets connectés et leur impact sur la vie privée sortent du cadre de ce rapport et n’y sont pas abordés. La description réalisée dans ce rapport des propriétés de l’habitat ayant un impact sur la santé est la première étape d’un processus visant à terme à proposer des lignes directrices pour les règles générales d’hygiène en matière de salubrité des habitations.

International audience

Dans le cadre du 3e Plan national de Santé Environnement (PNSE 3, 2015-2019), le HCSP a été chargé de mener une réflexion sur la prise en compte de l’évaluation des impacts sur la santé (EIS) dans les documents de planification territoriale. Les liens entre les différents déterminants de la santé et leurs impacts sur celle-ci sont exposés. Ensuite, les démarches et outils disponibles pour contribuer à l’intégration de la santé dans les documents d’urbanisme sont présentés. Enfin, les pratiques des différents acteurs sur le terrain en matière d’urbanisme et de santé sont intégrées à travers les retours d’expérience issus de nombreuses auditions.Le HCSP fait notamment les recommandations suivantes :• Adapter le Code d’urbanisme de manière à prendre systématiquement en compte la santé.• Mettre en place un Centre national de ressources en santé, environnement et urbanisme.• Élaborer et diffuser un plaidoyer national qui s’appuie sur le présent rapport.• Améliorer les compétences des acteurs.• Promouvoir une série de mesures spécifiques aptes à améliorer la prise en compte de la santé dans les documents de planification territoriale.• Renforcer la participation citoyenne afin que l’intégration de la parole du public concerné ne soit pas vécue comme une contrainte mais comme une valeur ajoutée au projet.

International audience; Introduction Green space in the built environment is an important topic on the health agenda today. Studies have shown that access to green spaces is associated with better mental and physical health, yet green spaces can also be detrimental to health if they are not managed appropriately. Despite the increasing interest in urban green spaces, little research has so far been conducted into the links between green spaces and cancer.Objective The purpose of this scoping review is therefore to map the literature available on the types of relationship between urban green spaces and cancer.Method and analysis We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 guideline to report the protocol. To conduct this scoping review, we will use a structured search strategy based on controlled vocabulary and relevant key terms related to green space, urban space and cancer. We will search MEDLINE (PubMed), GreenFILE (EBSCOhost), Cumulative Index to Nursing and Allied Health Literature (EBSCOhost) and ScienceDirect as electronic database as well as hand-search publications for grey literature. This review will therefore provide evidence on this current topic, one which could have practical implications for policy-makers involved in choices which are more conducive to healthy living.Ethics and dissemination No primary data will be collected since all data that will be presented in this review are based on published articles and publicly available documents, and therefore ethics committee approval is not a requirement. The findings of this review will be presented at workshops and conferences, and will be submitted for publication in a peer-reviewed journal.This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

The aim of this study is to investigate the integration of the health dimension within existing impact assessments such as environmental impact assessment (EIA), strategic environmental assessment (SEA) and sustainability assessment (SA). This work focuses on the canton of Geneva (Switzerland) and was carried out using the following methodology: a review of the legal texts and the guidelines that underpin the design and methodology of IAs; an analysis of the application of these tools in 37 case studies (11 SEAs and 20 EIAs conducted in Geneva as well as 6 SAs undertaken at national level); and conducting semi-structured interviews with selected professionals who participated in these case studies. Our study reveals serious shortcomings in the consideration of health within the investigated environmental assessments, limited to a simple review of the effects of projects on the determinants of the physical environment as required by the Swiss or local (Geneva) legislations. Regarding SA, our research finds that health is treated superficially and primarily through the analysis of ‘health and safety' criteria.

Brazil was one of the first countries in Latin America to institutionalize a National Environmental Policy in 1981, including the environmental impact assessment (EIA) process of economic activities with anticipated impacts on the environment. Today, EIA practice in Brazil comes with a number of limitations: it is constrained by its environmental advocacy role; application is strongly oriented towards large capital projects; and social responsibility considerations are only partially included. Consequently, EIA studies mainly address issues connected to localised and direct environmental impacts, largely ignoring any socio-economic and health impacts. This perspective paper highlights limitations of current EIA practice in Brazil with a focus on health considerations in impact assessment. While recognizing the positive impact to municipalities where large capital projects are being developed and operated, adverse impacts on health are a reality with measurable evidence in Brazil. Therefore, we argue that specificities on how to systematically assess and monitor potential health impacts cannot remain invisible in the Brazilian legislation, as currently seen in the reformulation of the licensing process in the country. The process of better integrating the assessment of health impacts in the licensing process of large capital project in Brazil must, however, not be based on the imposition of an external model but should be promoted by internal stakeholders from the environmental and health sector, incorporating the experiences gained in various case studies from all over the country.

International audience; After publication of the article [1], it has been brought to our attention that in the original publication the third author's name was spelt incorrectly. The correct spelling is "Emmanuelle Faure". This was previously spelt as "Emmannuelle Faure". The original article has been revised to reflect this.

International audience

Health impact assessment (HIA) is a prospective decision-making aid tool that aims to improve the quality of policies, programmes or projects through recommendations that promote health. It identifies howand through which pathways a decision can impact a wide range of health determinants and seeks to define the distribution of effects within populations, thereby raising the issue of equity. HIAwas introduced to the WHO European Healthy Cities Network as one of its four core themes during the Phase IV (2004-08). Here we present an evaluation of the use of HIA during Phase V (2009-13), where HIA was linked with the overarching theme of health and health equity in all local policies and a requirement regarding capacity building. The evaluation was based on 10 case studies contributed by 9 Healthy Cities in five countries (France, Hungary, Italy, Spain and the UK). A Realist Evaluation framework was used to collect and aggregate data obtained through three methods: an HIA factors analysis, a case-study template analysis using Nvivo software and a detailed questionnaire. The main conclusion is that HIA significantly helps promote Health in All Policies (HiAP) and sustainability in Healthy Cities. It is recommended that all Healthy City candidates to Phase VI (2014-18) of the WHO Healthy Cities European Network effectively adopt HIA and HiAP. © The Author 2015. Published by Oxford University Press. All rights reserved.

In this article we reflect on the quality of a realist synthesis paradigm applied to the evaluation of Phase V of the WHO European Healthy Cities Network. The programmatic application of this approach has led to very high response rates and a wealth of important data. All articles in this Supplement report that cities in the network move from small-scale, time-limited projects predominantly focused on health lifestyles to the significant inclusion of policies and programmes on systems and values for good health governance. The evaluation team felt that, due to time and resource limitations, it was unable to fully exploit the potential of realist synthesis. In particular, the synthetic integration of different strategic foci of Phase V designation areas did not come to full fruition. We recommend better and more sustained integration of realist synthesis in the practice of Healthy Cities in future Phases.

Background This paper presents the research protocol of the GoveRnance for Equity, EnviroNment and Health in the City (GREENH-City) project funded by the National Institute for Cancer (Subvention N°2017–003-INCA). In France, health inequities have tended to increase since the late 1980s. Numerous studies show the influence of social, economic, geographic and political determinants on health inequities across the life course. Exposure to environmental factors is uneven across the population and may impact on health and health inequities. In cities, green spaces contribute to creating healthy settings which may help tackle health inequities. Health in All Policies (HiAP) represents one of the key strategies for addressing social and environmental determinants of health inequities. The objective of this research is to identify the most promising interventions to operationalize the HiAP approaches at the city level to tackle health inequities through urban green spaces. It is a participatory interventional research to analyze public policy in real life setting (WHO Healthy Cities). Method/design It is a mixed method systemic study with a quantitative approach for the 80 cities and a comparative qualitative multiple case-studies of 6 cities. The research combines 3 different lens: 1/a political analysis of how municipalities apply HiAP to reduce social inequities of health through green space policies and interventions 2/a geographical and topological characterization of green spaces and 3/ on-site observations of the use of green spaces by the inhabitants. Results City profiles will be identified regarding their HiAP approaches and the extent to which these cities address social inequities in health as part of their green space policy action. The analysis of the transferability of the results will inform policy recommendations in the rest of the Health City Network and widely for the French municipalities. Discussion/conclusion The study will help identify factors enabling the implementation of the HiAP approach at a municipal level, promoting the development of green spaces policies in urban areas in order to tackle the social inequities in health. Electronic supplementary material The online version of this article (10.1186/s12889-017-4812-8) contains supplementary material, which is available to authorized users.

The purpose of this article is to review the status of Health Impact Assessment (HIA) in Switzerland and assess whether HIA can be used to implement Health in All Policies (HiAP) in this highly decentralized country. The methods include expert opinion and an extensive literature review, as well as targeted interviews with key informers in the cantons of Geneva, Jura and Ticino. HIA has been implemented successfully since the early 2000s in Switzerland. However, integration has been heterogeneous with only a few cantons taking the lead. Integration of HIA at the federal level was attempted in 2012 but failed due to resistance from a pro-business lobby. HIA in Switzerland has the potential to contribute to HiAP, but success depends on a wider dissemination of HIA and on some form of integration at the national level. In this respect, a ‘bottom-up’ approach based on inter-cantonal collaborations appears more promising than the ‘top-down’ federal level approach.

This study aims to understand how the health dimension is integrated into four impact assessment tools used in Geneva, Switzerland: environmental impact assessment (EIA), strategic environmental assessment (SEA), sustainability assessment (SA) and health impact assessment (HIA). We have chosen as a case study greenhouse gas (GHG) emissions reduction policies chosen by the city of Geneva. The methodological approach consists in analysing EIA, SEA, SA and HIA conducted on three projects in three topic areas: urban planning, heating and transportation. These projects are: a complex urbanisation plan in an urban neighbourhood in Geneva (the Gare des Eaux-Vives project), a sustainable transportation plan for a central district in Geneva (the St-Gervais transportation project) and a strategy to encourage the City’s employees to use sustainable transport for local business travel. The results show some shortcomings in the consideration of health in SEA, EIA and SA. This work highlights a narrow vision of health in SEA and EIA, limiting itself to a review of the effects of projects on the determinants of the physical environment as required by the legislation relating to these tools. EIA does not require the integration of the health dimension. As for SA, our research found that health is treated much more superficially than in HIA and primarily through the analysis of ‘health and safety’ criteria. It appears from this work that HIA is the tool which provides the most elaborate assessment, compared to SA, SEA or EIA, of the consequences for health of the GHG reduction policies chosen by the local decision-makers of a city. However, our study suggests that the HIA community should identify the situations in which HIA should be carried out and in which cases it is better to include health issues within an integrated analysis.

HIA has emerged as a privileged tool for the implementation of health in all policies (HiAP). It is a vehicle to help health practitioners inform societal decision-making and can be very effective in the decision-making process as a decision-aid tool.

In this chapter we review the first five chapters of the book through the lens of social movement theory and within a gaze of glocal health (the idea that the global and the local have become inextricably connected) development and evidence. We seek a foundation for the case material in Part II of the book in the documented evidence of Healthy Cities, communities, and villages around the world, and in particular in the series of evaluations carried out for the European Region of WHO Healthy Cities networks. As such, the chapter provides a comprehensive update on the empirical evidence for Healthy Cities around the world. It ends with a reading guide for the ‘regional’ case material in Part II of the book and a justification for the material compiled in that section.

In Switzerland, the federal authorities, the cantons, and the communes share the responsibility of healthcare, disease prevention and health promotion policies. Yet, the cantons are in most health matters independent in their decisions, thus defining as a matter of fact their own health priorities. We examined and analysed the content of the disease prevention and health promotion plans elaborated during the last decade in six French-speaking cantons with different political contexts and resources, but quite similar population health data, in order to identify the set health priorities. The plans appear significantly inhomogeneous in their structure, scope and priorities. Most of the formal documents are short, in the 16 to 40 pages range. Core values such as equity, solidarity and sustainability are explicitly put forward in 2/6 cantonal plans. Priority health issues shared by all 6 cantons are “physical activity/sedentariness” and “nutrition/food.” Mental health is explicitly mentioned in 5 cantonal plans, whereas tobacco and alcohol consumptions are mentioned 4 times. Less attention has been given to topics that appear as major public health challenges at present and in the future in Switzerland, eg, ageing of the population, rise of social inequalities, increase of vulnerable populations. Little attention has also been paid to issues like domestic violence or healthy work environments. Despite some heterogeneity, there is a common base that should make inter-cantonal collaborations possible and coordination with national strategies easily feasible.

In this chapter we attempt to systematically analyse the case studies provided for the different regions in Part II of the book. We argue that a degree of systematizing of Healthy Cities around the world is warranted. However, the evidence generated in Part II shows that each Healthy City is unique, with a unique context and unique set of governance and operational parameters. This is no surprise, and we continue to explain why any effort at collective analysis must first and foremost take into account the matter of glocal values and political choice. The argument is grounded in political philosophy and efforts to frame political cultures across nations and (social and political) environments. We present the statements to come out of pivotal 2016 meetings (the Habitat 3 Quito statement and the WHO Shanghai health promotion declaration) as sharing the value system that is also espoused by the Sustainable Development Goals and the new Global Public Health Charter. (Healthy) Cities have been working towards these value systems for three decades now, and seem well placed to continue to take a lead in the grand challenges of urban health—as presented in Part III of this book.

Africa is one of the least urbanized continents. Less than 40 % of the population (413 million of over one billion) lived in urban areas in 2011. This situation is changing rapidly, and in 2050 around 70 % of the continent’s population is expected to be urban. This extremely fast pace means that the gap between Africa and other continents is closing rapidly—the world average was 52.1 % in 2011 (see Fig. 6.1).

Europe has played an important role in the global development of Healthy Cities. The Regional WHO Bureau in Copenhagen was the first to implement the Healthy Cities concept, with partners from North America and through an initial network of cities in Europe. The network was then consolidated and expanded through several successive 5-year phases. Facilitating the creation of national WHO Healthy Cities networks ensured further diffusion of the idea. This relatively formal structure has ensured that Healthy Cities is the only programme where WHO liaises not with Member States ministers but with the mayors of cities or conurbations. Working in coordinated by WHO networks has favoured the exchange of information between partners as well as the pursuit of common goals. It has also allowed the production of structured and innovative evaluations, impossible to produce by each participating city in isolation. The European model is therefore a useful way of implementing the Healthy Cities concept. It ensures a certain degree of homogeneity, which does not prevent novel concepts from emerging, such as the Green Fork label, used in catering.