Table 3

Analysis of quantitative HIA studies: types of determinants, health outcomes and modelling, source of risk measures, and uncertainty

	Study	Proximal/distal determinants*	Type of health outcomes	Type of modelling in outcome assessment	Source of risk measures linking determinant to health	Time horizon	Uncertainty
*Distal determinants affect health through intermediary factors. An example is income, which affects health via material circumstances, access to care, self esteem, etc.
1	Hallenbeck (1995): waste facility	Proximal	Life time cancer risks	Quantitative risk assessment (QRA)	Toxicological risk assessment based upon animal experiments	70 years	Point estimates of maximum exposure only
2	Dunt (1995): highway	Proximal	Road traffic injuries	Traffic accident model	Local historical data on accidents by type of crossing	10 years	Report includes sensitivity analysis
3	Zwart (1997): alcohol	Proximal	Number of excessive drinkers	Simple algorithm (Ledermann formula)	Cross country comparison	Unclear	Point estimate only
4	Mooy (1998): tobacco	Proximal	Disease-specific death rate, life years gained	Macro-simulation model with dynamic population (PREVENT)	Epidemiological evidence	50 years	Point estimates only
5	Fehr (1999): waste facility	Proximal	Additional lifetime cancer risk, additional pop. cancer burden	Quantitative risk assessment (QRA) computer program	Toxicological risk assessment based upon animal experiments	70 years	Point estimates only
6	Fehr (1999): highway	Proximal	Additional lifetime cancer risk, additional pop. cancer burden	Quantitative risk assessment (QRA) computer program	Toxicological risk assessment based upon animal experiments	70 years	Point estimates only
7	Kemm (2000): home insulation	Proximal	Deaths per year	Innovative method	Ecological studies	Unclear	Point estimate dubbed “no more than a possible figure”
8	France (2000): freight distribution centre	Proximal	Mortality, morbidity, restricted activity days, hospital admissions.	Epidemiological risk assessment; three formulas for prediction of traffic accidents	Epidemiological studies; regional data.	Unclear	Air pollution: average and max. rates. Road traffic accidents: 3 point estimates.
9	Kemm (2000): woodprocessing plant	Proximal	Road traffic accident deaths and injury-only accidents	Analogy	National historical data on average number of accidents per distance travelled.	Unclear	Point estimate, uncertainty expressed by prefix “about”.
10	Kemm (2000): botanic garden	Proximal (accidents) and distal (income)	Road traffic accident injuries and deaths and %-age change in overall mortality (income)	Analogy (accidents); extrapolation from national data	National historical data on average number of accidents per distance travelled.	Unclear	Point estimates based upon “very uncertain assumptions”.
11	Taylor (2001): port extension	Proximal (air pollution, accidents) and distal (employment)	Respiratory deaths and hospital admissions; road traffic accident injuries; premature deaths (due to unemployment)	Epidemiological risk assessment (air pollution, employment); analogy (accidents).	Epidemiological studies (air pollution); local data (traffic accidents); single epidemiological (longitudinal) study (employment)	Unclear	Point estimates only (air pollution); terms like “3–4” and “<1” (traffic casualties); “just over three deaths” (employment).
12	Jobin (2003): Chad pipeline	Proximal	Deaths per year	Analogy (accidents, malaria), infectious disease model (HIV)	USA historical data (accidents); epidemiological study Nigeria (malaria), ? epidemiological data (HIV transmission rates)	Unclear	Point estimates of “likely” effects, intended to rank issues.
13	Fehr (2003): drinking water	Proximal	Additional lifetime cancer risk, additional cancer cases in pop.	Quantitative risk assessment (QRA)	Toxicological risk assessment based upon animal experiments (?)	70 years	Point estimates and 5th and 95th centiles per increase of exposure (uncertainty in degree increase not quantified)
14	UK Dept. of Health (2001): foot and mouth disposal	Proximal	Additional variant Creutzfeldt-Jakob Disease infections as function of %-age of older cattle destructed.	Unclear	Unclear	Unclear	Point estimates with 95% confidence range.
15	Abrahams et al, (2002): foresight vehicle initiative	Proximal	Annual deaths and serious injuries (traffic accidents); first hospital admissions (air pollution)	Macro-simulation model with dynamic population (ARMADA)²⁴	Epidemiological evidence	2000–2029	Point estimates, uncertainty expressed by prefix “approximately”
16	Pitches and Kemm 2003): regional planning guidance transport chapter	Proximal	All-cause, cardiovascular and colon carcinoma deaths per year(s), acute myocardial infarction cases per year(s) (physical activity); slight, serious & fatal injuries (traffic accidents)	Epidemiological risk assessment (physical exercise); analogy (traffic accidents)	Epidemiological evidence (physical activity); national historical data on average number of serious personal accidents per distance travelled and mode of transport	Unclear	Mainly estimates in terms like “one death per 2 or 3 years”, and general word of caution: “estimates have very wide margin of error”