Assessing the unintended health impacts of road transport policies and interventions: translating research evidence for use in policy and practice.
BACKGROUND
Transport and its links to health and health inequalities suggest that it is important to assess both the direct and unintended indirect health and related impacts of transport initiatives and policies. Health Impact Assessment (HIA) provides a framework to assess the possible health impacts of interventions such as transport. Policymakers and practitioners need access to well conducted research syntheses if research evidence is to be used to inform these assessments. The predictive validity of HIA depends heavily on the use and careful interpretation of supporting empirical evidence. Reviewing and digesting the vast volume and diversity of evidence in a field such as transport is likely to be beyond the scope of most HIAs. Collaborations between HIA practitioners and specialist reviewers to develop syntheses of best available evidence applied specifically to HIA could promote the use of evidence in practice.


METHODS
Best available research evidence was synthesised using the principles of systematic review. The synthesis was developed to reflect the needs of HIA practitioners and policymakers.


RESULTS
Aside from injury reduction measures, there is very little empirical data on the impact of road transport interventions. The possibility of impacts on a diverse range of outcomes and differential impacts across groups, make it difficult to assess overall benefit and harm. In addition, multiple mediating factors in the pathways between transport and hypothesised health impacts further complicate prospective assessment of impacts. Informed by the synthesis, a framework of questions was developed to help HIA practitioners identify the key questions which need to be considered in transport HIA.


CONCLUSIONS
Principles of systematic review are valuable in producing syntheses of best available evidence for use in HIA practice. Assessment of the health impacts of transport interventions is characterised by much uncertainty, competing values, and differential or conflicting impacts for different population groups at a local or wider level. These are issues pertinent to the value of HIA generally. While uncertainty needs explicit acknowledgement in HIA, there is still scope for best available evidence to inform the development of healthy public policy.
Thomson
Hilary
H
MRC Social & Public Health Sciences Unit, Glasgow, UK. hilary@sphsu.mrc.ac.uk
Jepson
Ruth
R
Hurley
Fintan
F
Douglas
Margaret
M
D000063:Accidents, Traffic / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D006293:Health Promotion; D006302:Health Services Research; D006801:Humans; D018986:Motor Vehicles; D011314:Preventive Health Services / Q000379:methods*; D011640:Public Policy; D014186:Transportation / Q000331:legislation & jurisprudence*; D014947:Wounds and Injuries / Q000517:prevention & control