Background
HIA of the Bay of Pasaia
Methods
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Firstly, stakeholder and community perspectives were gathered qualitatively (18 in-depth interviews and 5 focus groups). In addition, to promote community participation in the evaluation process by giving an active voice to players in aspects of municipal life, this approach allowed people to give their views on the projects and impacts, and suggest potential improvements. It also provided data on the relationships between the socio-historical, urban, and health-related dimensions. Sessions were recorded and transcribed upon consent. Analysis was performed from a sociological discourse analysis perspective. More details of the qualitative study have already been published [13].
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Secondly, quantitative data was gathered to gauge the magnitude of the problems and impacts and complement the results of the qualitative study (Table 3). Three hundred three residents selected from the telephone directory using quota sampling according to deprivation in the area of residence, age and sex, were interviewed by phone. The quotas were proportional to these variables in the population. Residence census tracts were categorised into 2 groups according to the deprivation index [14] (least deprived: deprivation index within quintiles I-III vs most deprived: deprivation index within quintiles IV-V); age was also grouped into 2 categories (18–44 vs 45–79 years). Telephone numbers were grouped by deprivation index of the corresponding census tract and selected by random-digit dialling until each quota was complete. Information on impacts, community support for recommendations and their potential effects on lifestyle, and people-place attachment, was collected using a structured questionnaire. Verbal informed consent was obtained from all participants.
Evaluation phase | Evaluation method | Study population | Study contents |
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a) Project characteristics | Review of the technical documentation provided by the sponsor institutions | LH and NFM projects | Analysis of projects: design, location, target population and other affected groups, effects on social inequalities, implementation schedule. |
Interviews with architects of the Master Plan and managing engineers | LH and NFM projects | ||
b) Characterisation of the study area and population | Socio-demographic records | Population of the study area | Sex, age, origin, education level, deprivation index, relation to activity. |
Health records: mortality, cancer, hospital discharges, primary care records Basque Health Survey | Population of the study area | Health status of the population, chronic diseases. Health habits of the population | |
Environmental records: air, noise, and soil pollution | Study area | Contamination levels: PM10 particles in air, ambient noise, degraded terrain. | |
Urban quality data | Study area | Population density, green spaces | |
Direct observation by HIA team | Study area and plots for LH and NFM. Urban dynamics | Physical characteristics of the area Initial state of the plots and their surroundings Person-space relationship: places of significance | |
c) Search for scientific evidence | Review of scientific literature: - Health-specific sources: Medline, Embase, The Cochrane Collaboration, Campbell Collaboration, Health Evidence Network - Multidisciplinary sources: Web of Knowledge, SCOPUS - HIA-specific portals: CREIS, HIA Gateway, WHO, e IMPACT-Health Impact Assessment International Consortium | Publications, studies, reviews, documents, reports from similar HIAs | Search for evidence on the following SDH: - urban quality: recreational areas, green spaces, footpaths, walkability - safety - transport and accessibility: access to services, nearby traffic, noise and pollution associated with traffic - employment and economic dynamism - social networks, social cohesion and collective self-esteem |
d) Mixed methods: Qualitative and quantitative research | Stakeholder and community group perspective: qualitative study - In-depth interviews |
N = 18 qualified participants (representatives of associations, neighbourhood organisations, health professionals, town planners) | Identification of: - interrelationships between socio-historical, urban, and health-related dimensions in the context of the studied projects - public perception of the project effects on the urban environment and health/quality of life - health inequality-related issues Channelling the participation of affected populations in the assessment process. Collection of proposals for potential improvements |
- Focus groups Data analysis: sociological discourse analysis |
N = 5 groups, stratified according to age, social class, and activity (youths, housewives, adults, senior citizens) | ||
Magnitude of problems and impacts: quantitative study - Quota sampling by deprivation index of the census tract of residence, sex, and age - Telephone survey - Analysis: descriptive, inter-group comparison, Chi square test |
N = 303 residents | Identification and quantification of: - deficits and problems in the area - places of significance, attachment to environment and social identity - potential effects of improved urban quality on lifestyle and collective self-esteem - social inequalities according to sex, age and socioeconomic status |
Socio-demographic characteristics | Study area | Gipuzkoa | ||||
- Inhabitants | 20,862 | 705,210 | ||||
- > = 65 years (%) | 22.3 | 19.8 | ||||
- Unemployment rate (%) | 12.9 | 10.1 | ||||
- College education (%) | 15.6 | 23.3 | ||||
- Foreign-born residents (%) | 8.0 | 6.5 | ||||
Environmental characteristics | Study area | Standard values | ||||
- Housing density (dwelling/ha) | 130.5 | 60.6 | ||||
- Green spaces (%) | 10.5 | 20.1 | ||||
- PM10: high peaks (μg/m3) | 48–228 | 50 (daily average) | ||||
- Noise levels daytime/night-time (dB(A)) | 10 dB(A) higher than standard values | 65/55 | ||||
- Degraded land (ha) | 11 | -- | ||||
Study area | Gipuzkoa | |||||
Health status | Men | Women | Total | Men | Women | Total |
Morbidity | ||||||
- All cancers (rates × 1003 inhabitants. Age-adjusted to European population)a
| 972.1** | 403.9** | 639.01** | 513.03 | 275.9 | 377.6 |
- Chronic obstructive pulmonary disease (cases/100 IHC)b
| 2.87** | 1.15** | 1.99** | 1.74 | 0.82 | 1.61 |
- Diabetes mellitus (cases/100 IHC)b
| 6.59** | 6.45** | 6.51** | 5.37 | 4.23 | 4.79 |
- Arterial hypertension (cases/100 IHC)b
| 17.94** | 20.54** | 19.28** | 15.90 | 16.38 | 16.17 |
- Anxiety-depression (cases/100 IHC)b
| 5.18** | 14.18** | 10.05** | 3.64 | 8.82 | 6.27 |
Risk factorsc
| ||||||
- Obesity (%) | 15.6 | 15.3 | 15.4* | 14 | 11.9 | 12.9 |
- Smoking (%) | 31.8 | 26* | 28.9* | 28 | 19.3 | 23.5 |
- Sedentary lifestyle (%) | 57.5 | 57.2 | 57.3* | 45.3 | 53.2 | 49.4 |
All-causes of mortality (rates × 1003 inhabitants). Age-adjusted to European population)d
| 860.6** | 354.6 | 567* | 694.7 | 353.8 | 502.6 |
Consumption of psychotropic drugs (DDD)e
| - | - | 75.6** | - | - | 51.9 |
Hospital admissions (rates × 1003 inhabitants). Age-adjusted to standard European population)f
| 1203.3** | 1019.8** | 1086.2** | 995.3 | 913.7 | 940.4 |
Problems in the area | Total % (CI-95 %) | Deprivation levela
| Sex | Age | ||||||
---|---|---|---|---|---|---|---|---|---|---|
High | Low |
p
| Men | Women |
p
| 18–44 | 45–79 |
p
| ||
Lack of recreational areas | 68.7 % (63.4–73.9) | 60 % | 72 % | 0.03 | 69.1 % | 68.2 % | N S | 70.8 % | 66.4 % | NS |
Walking difficulty | 37.5 % (31.9–43.0) | 37 % | 37.8 % | NS | 32.1 % | 43 % | 0.05 | 38.6 % | 36.4 % | NS |
Use of metro | 39.3 % (33.7–44.7) | 28 % | 46 % | 0.003 | 38 % | 40.5 % | NS | 40.4 % | 38.1 % | NS |
Lack of emblematic locations | 35.3 % (29.9–40.7) | 30 % | 38 % | NS | 30 % | 40.5 % | 0.05 | 32.7 % | 38.1 % | NS |
Potential effect attributed to recommended improvement: pedestrian walkway | ||||||||||
Increases physical activity | 78.4 % (73.7–83.1) | 73 % | 81 % | 0.06 | 75 % | 81.7 % | NS | 84 % | 72.4 % | 0.01 |
Increases use of the metro | 64 % (58.5–69) | 56 % | 68 % | 0.02 | 63.4 % | 64.5 % | NS | 70.6 % | 56.9 % | 0.01 |
Improves sociability | 81.6 % (77.2–86) | 87 % | 79 % | NS | 79.6 % | 83.6 % | NS | 86.5 % | 76.4 % | 0.01 |
Increases leisure opportunities | 63.5 % (58.1–69) | 56 % | 67 % | 0.04 | 61.6 % | 65.4 % | NS | 67.1 % | 59.7 % | NS |
Increases attractiveness of area | 90.2 % (86.9–93.6) | 98 % | 86 % | 0.001 | 91.1 % | 89.4 % | NS | 92.9 % | 87.3 % | NS |
Intervention phenomena | Structural and proximal determinants affected | Vulnerable groups and social inequalities in health | Potential health effects | Source of evidence |
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Characteristics of the new fish market (walkable roof garden and emblematic building) |
Green spaces and recreational areas
(+) ↑ physical activity (+) ↑ unstructured activities and social interaction
Pedestrian walkways
(+) ↑ physical activity (+) ↑ efficiency of land use (+) ↑ access to services and employment
Urban quality
(+) ↑ physical activity (+) ↑ diet quality (+) ↑Social cohesion
(+) ↑ Individual and social self-esteem
(+) ↑Employment and social dynamism | Positive effects on the population in the area next to the fish market, in particular those who are unemployed and/or have low incomes, no car, and cyclists, pedestrians, women, children, and the elderly | (+) ↑ wellbeing and quality of life (+) ↓ poor mental health (+) ↑ self-esteem (+) ↓ stress and fatigue (+) ↑ perceived physical health (+) ↑ sleep quality (+) ↓ chronic diseases: cardiovascular disease, diabetes, arterial hypertension, obesity and others (+) ↓cancer (+) ↑musculoskeletal health (+) ↓premature mortality | Qualitative study Quantitative study |
Operation and activity of the fish market |
Environmental quality
(−) ↑ Noise, odours, persistence of pollution
Persistence of heavy traffic
(−) ↑Accident rate | Negative effects on the entire population, especially in urban areas close to the market and the associated access roads. Increased risk of accidents for children, youths, and the elderly | (−) ↓ mental health, ↑stress and irritability (−) ↑ cognitive disorders in children (−) ↑ cardiovascular disease, cancer, mortality due to diabetes mellitus and other causes, and exacerbation of COPD and asthma (−) ↑ injuries, accident-related disabilities | Qualitative study |
Effects of non-intervention | Affected social determinants of health | Vulnerable groups and social inequalities in health | Potential effects on health and bibliographical sources | |
---|---|---|---|---|
Persistence of degraded area |
Deteriorating physical environment
(−) ↓ physical activity (−) ↓ active transport (−) ↓ social cohesion and collective self-esteem
Perception of insecurity
(−) ↓ physical activity (−) ↓ social cohesion (−) ↓ employment and economic activity | Negative effects on the entire population, especially women, the elderly, children, and those with low incomes | (−) ↑ obesity, DM II, hypertension, and cancer (−) ↓ musculoskeletal health (−) ↓ perceived physical and mental health (−) ↑ depression and anxiety (−) ↓ sleep quality (−) ↓ self-esteem (−) ↑ stigma and psychosocial stress | Qualitative study Quantitative study |
Underfunding of potential uses of the area |
Mixed use of land and recreational areas
(−) ↓ active transport (−) ↓ social interaction | Negative effects on the entire population, particularly pedestrians and those with low incomes | (−) ↑obesity (−) ↓mental health and wellbeing | Qualitative study Quantitative study |
Unsafe and unequal access to metro |
Accessibility, public transport and connectivity
(−) ↓ physical activity (−) ↓ access to services (−) ↑isolation and ↓social cohesion (−) ↑contamination, noise and accidents due to increased traffic | Negative effects on the entire population, particularly women, children, the elderly, ethnic minorities, the disabled, and those with low incomes | (−) ↑ obesity and chronic diseases (−) ↓ mental health (−) ↑ cardiovascular disease, exacerbation of COPD and asthma, cancer, mortality (−) ↑ irritability, stress and sleep disorders | Qualitative study Quantitative study |
Worsening of conflict with sponsor institutions |
Psychosocial sphere
(−) ↑ mistrust of institutions (−) ↑ sense of social frustration (−) ↓ sense of belonging to the community, collective identity and self-esteem | Negative effects on the entire population, particularly those who are socially excluded. | (−) ↓ physical and mental health | Qualitative study |
NFM recommendations | |
Design a route for heavy vehicles to the market via the port road, outside the urban centre. | |
Establish a speed limit for road traffic and lay noise-absorbing asphalt along the route for heavy vehicles to the market in order to minimise noise and emissions. | |
Establish a heavy vehicle parking area in the port area so that trucks waiting to load or unload in the market do not saturate the town’s parking areas. | |
Establish regulations to ensure that engines of vehicles parked in loading/unloading areas are switched off, thus minimising noise and emissions. | |
Provide soundproofing and particle filtering systems for ventilation systems located along the NFM’s walkable roof garden. | |
Provide sufficient adequate lighting for the walkable roof garden, avoiding discomfort to the residents of the nearby houses, particularly those located at the same level as the walkable roof. | |
Recommendations in response to delays in the LH project | |
Prioritise regeneration of this area by planning for mixed land use, based on key deficits in the area (insufficient recreational areas, green spaces and parking areas). | |
Involve the affected population in the decision-making process and keep them informed of the resolutions taken. | |
Remove piles of demolition debris from the plot and clean and sanitise the area. | |
Disinfect and apply pest control measures to buildings in the area, pave the plot and maintain the fence in an appropriate condition. | |
New opportunities linked to the projects: pedestrian walkway | |
Create a pedestrian walkway from the metro station to the mouth of the harbour, along the water’s edge. | |
Provide new outdoor recreational areas including equipment that promotes physical activity and social relationships, applying the criteria of accessibility for all. | |
Adequately illuminate the pedestrian walkway to minimise light pollution. | |
Create green spaces, applying economic and environmental sustainability criteria: non-invasive, non-allergenic species with non-costly maintenance. |