Original Title: Evaluación del impacto en la salud del Plan de Reforma Integral de Uretamendi-Betolaza y Circunvalación

Authors' objectives: The aim of the health impact assessment (HIA) was to carry out a concurrent and prospective evaluation of the impact on health and social inequalities in health of the Integral Regeneration Project (IRP) of Uretamendi-Betolaza and Circunvalación (UBC). Such an evaluation would (a) identify the positive and negative impacts on the health of the population of UBC, (b) estimate the magnitude and distribution of these impacts (according to age, sex, socio-economic status, etc.), (c) recommend improvements in the project, and (d) propose indicators to monitor the impact of the project on health.

Authors' results and conclusions: 4.1. Characteristics of the population The age structure of the population of UBC (2,722 inhabitants in 2005) was less elderly than that of Bilbao. Socio-economically, UBC was of special interest due to its higher proportion of persons with manual jobs and its higher percentage of unemployment, insufficient education levels (also among the population aged 16-29), and part-time workers than in the rest of the area and in Bilbao. These differences were more pronounced among men. Nevertheless, residents considered that their quarter was less noisy and less contaminated than the rest of the area and Bilbao. All-cause mortality was higher in UBC than in Bilbao. With regard to specific causes, both in men and in women there was a higher risk than in Bilbao of mortality due to COPD, diabetes and AIDS, and to lung cancer only in men. On the other hand, among women, the risk of death due to lung cancer, pneumonia and influenza was lower than the total for Bilbao. A lower risk of mortality due to colon cancer in both sexes was also observed. With regard to mental health, the disorders of the population of UBC that required attention most frequently in the Psychosocial Care Module in Rekalde were, in the case of women, emotional disorders and anxiety, and in men, those deriving from alcohol and drugs. 4.2. Review of the literature With regard to the most relevant aspects detected in this HIA, the evidence indicates that by facilitating mobility, the resulting improvements in accessibility have an influence on physical activity, strengthen social networks and increase the level of social cohesion with the rest of the city. This is associated with a lower mortality rate and higher levels of perceived health. The increase in the volume of traffic may, nevertheless, increase the mortality rate due to injuries caused by accidents, especially in the lower socio-economic groups. The presence of green areas is associated with higher levels of perceived health and better mental health, and encourages physical activity. This also increases the interaction between people, bringing about greater social cohesion. However, the possible use of these spaces for activities such as the consumption of alcohol and drugs may have a negative effect on the health of residents. Improvements in the system of rainwater collection will reduce dampness levels in homes with a consequent decrease in the risk of respiratory diseases and the possibility of falls in the street, and bring about a drop the mortality rate due to accident-related injuries. The extremely low-frequency electromagnetic fields produced by underground high voltage power lines will be lower than those generated by overhead lines. 4.3. Qualitative study The views of participants concerning the IRP and its effects on their health seem to be linked to the social and historical context of a district characterised by a history of inadequate infrastructures and urban planning. The precariousness of their existence and the perception of residents of being marginalised from the rest of Bilbao have conditioned both their expectations of the present and the future. By considering the IRP as a dynamic process, a number of shortcomings linked to information and communications between the different agents can be identified. These have a bearing on the views of residents on the impact on health of the IRP. Seven health impact areas, which require attention and in which there is room for improvement, have been defined. These are: accessibility and mobility, rainwater and sewage collection, parks, leisure and the underground installation of electrical power lines, car parks and vehicle traffic, the importance of minor questions and other problems, the sensation of being a member of society and social cohesion. People’s perceptions of the impact of this project differ in accordance with the area where they reside. The poor quality accesses and urban planning in Betolaza are seen as a stand-alone issue, setting this district off from the other two. 5. Identified impacts Impacts are grouped in accordance with the different areas of the IRP project: • Lifts and roads: Three kinds of accessibility will be improved relating to: (a) Greater incoming and outgoing mobility in this neighbourhood, which will strengthen social networks and improve social cohesion with the rest of Bilbao. It will encourage people to walk, bringing about an increase in physical activity. These factors are associated with several positive effects on health. Nevertheless, the increased flow of traffic created on the new roads and the planned exits from the lift between Uretamendi and Betolaza may increase the number of road accidents involving pedestrians, leading to arise in accident morbimortality. (b) The improved access of the community to social and health services and the greater accessibility of these to the neighbourhood in the form of better roads. This will improve the prevention, diagnosis and treatment of illnesses and will lead to a better quality of care. (c) Increased access to other services, which will allow greater access to a wider variety of resources, of doubtful impact on health. This improvement in accessibility will have a greater impact in Uretamendi and Circunvalación, as well as on persons with mobility problems, those who do not have their own private means of transport and parents. • Construction of the Park of Gaztelapiko: The perception of one’s place of residence will improve, which is associated with a higher level of perceived health and mental health. Mild forms of physical exercise (walks), associated with a large number of positive effects on health, will increase. Interpersonal communications will also improve, strengthening social networks and social cohesion, with positive effects on health. Nevertheless, its use for activities such as consuming alcohol and other drugs may provoke an increase in negative attitudes (anxiety … ) as well as other negative aspects for the health of residents. The positive impact of the Park will be lower in Betolaza and greater among the elderly, the more disadvantaged socio-economic groups and parents. • Improvement in the rainwater collection system: Dampness in homes will be reduced, bringing about a reduction in the number of cases of respiratory illnesses. Moreover, the reduction in the flow of water that circulates in the streets will improve the state of stairways and pedestrian ways, as well as the access to these, thereby reducing morbidity rates due to accidental falls. • Development of the HIA: This issue also requires analysis due to its possible impact on health. The participation of residents and their capacity to influence events (based on adequate communications and participation channels with the town hall) and the view they have of their ability to control their own eighbourhood may have a positive influence on their perceived health and mental health.

Authors' recommendations: The recommendations made were as follows:• Maximise improvements in accessibility and mobility by improving access to Betolaza and to the interiors of homes throughout UBC, ensuring a safe exit from one of the lifts and preventing excess speed on the new roads.• Ensure adequate use and enjoyment of the Park of Gaztelapiko, preventing its use for antisocial activities and providing the necessary equipment for a broad spectrum of society. Likewise, the report recommends the creation of a «green route» to join Rekalde with the Park, which could continue towards the mountain called Arraiz/Caramelo. Likewise, all the other green and leisure spaces must be adequately maintained and the preparation of other spaces for use by residents must be promoted.• In future installations or in modifications of these, which may be a source of electromagnetic fields of extremely low frequency (ELF) within the municipality of Bilbao, aspects of safety, reliability and economy must be taken into consideration. Likewise, a programme of protection against low-frequency electromagnetic fields must be established within the scope of municipal responsibility, to include the measurement of fields of all sources to ensure that these do not exceed the exposure limits established for the general or working population. • Establish adequate communications channels between the town hall and residents, both during and after construction work, as well as measures to reduce problems deriving from construction work.• Check and readjust municipal services in the district, such as cleaning, maintenance of street furniture and police surveillance.• Strengthen the social cohesion between UBC and Bilbao as well as between the three areas of the neighbourhood. To do this, it is proposed to increase community life and improve accessibility to the civic centre, reinstate the signs of identity of the district, involve professionals who work in/for the district in the projects and identify the needs of each subgroup con especial emphasis on the young.

Authors' methods: In accordance with HIA methodology, the work was divided into the following stages: • Screening: At a meeting of the research group and using an existing tool, a preliminary assessment was made of the possible impacts of the project on the health of the population. In conclusion, it was decided that it would be appropriate to carry out an assessment as the project involved several areas of uncertainty and others in which there was room for improvement. • Design and planning: the terms of reference of the assessment were defined (objectives, methods, depth and space-time limits). In order to supervise the process, a Steering Group and a Monitoring Group were set up. • Assessment: The following actions were taken: (a) the project was analysed; (b) a systematic review of the bibliography was conducted on the effect of the different elements envisaged in the IRP on the health of the population; (c) the socio-demographic aspects and health of the population were characterised; and (d) a qualitative study was carried out with the aid of key informants, health system professionals and local residents (discussion groups and in-depth interviews). • Report on impacts and recommendations: Following an analysis of the data, the research team extracted the most relevant impacts of the IRP on health and drew up recommendations for improvement. • Monitoring and assessment: The team carried out an assessment of the HIA process and proposed the bases on which the assessment of its impact and results were to be made.

Project Status: Completed

Year Published: 2009

URL for published report: https://www.euskadi.eus/contenidos/informacion/2009_osteba_publicacion/es_def/adjuntos/d_09_04_eval_imp_sal.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Basque Office for Health Technology Assessment (OSTEBA)</p>