Twinning project to support the implementation of Health Impact Assessment practice in Georgia

Health and environment are very linked with one another. Human activities are the main source of climate change and emission of harmful substances (chemicals, pollutions …). Air pollution for instance is detrimental for health in many ways and causes cardiovascular diseases. Even though air quality in Europe has improved over recent decades, the levels of air pollutants still exceed EU standards and the most stringent World Health Organization guidelines. Air pollution in the EU led to more than 307 000 premature deaths in 2019 mainly due to man-made emissions and industrial pollution costed at least 233 billion EUR in 2017.

In Georgia, air pollution levels exceed very frequently EU and WHO guidelines (especially in Tbilisi and Rustavi, accounting for more than 1/3 of the Georgian population). More than 3,741 deaths can be attributed to air pollution directly and cardiovascular diseases remain the leading cause of deaths since 1990.

Moreover, foreseen impacts of climate change for the Caucasus country include:

• more frequent, stronger and longer heatwaves, especially in urban settings (Telavi, Tbilisi and Zugdidi) and affecting primary vulnerable populations;

• more regular and stronger natural disasters like floods;

• change of infectious patterns: higher incidence of foodborne and waterborne infections, but also in a higher incidence of infections transmitted by vectors (transmitting insects).

The Government of Georgia and its international partners are active in addressing environmental health and the impacts of climate change on health. The second National Environmental Health Action Plan (2018-2022) identified 5 priority areas for public policy and action : promotion of a healthy lifestyle, reduction of outdoor and indoor air pollution, improvement of water quality through safe water and sanitation, prevent morbidity caused by exposure to chemicals and integration of health issues in climate change adaptation and mitigation policies.

In the framework of Environmental Assessment Code of Georgia (2017) and impact assessments, HIA is a mandatory process for strategic planning in different sectors : planning authorities have to go through an application and validation process according to different scales. HIA relies on the concept of health determinants (environmental but also socio-economic), public participation and health promotion. The twinning project financed by the EU takes place in this strategic framework and will support the National Center for Disease Control and Public Health (NCDC) in improving the practice of Health Impact Assessment.

1- Planning authorities deliver a dossier with different information about the planned project/strategic document to the Ministry of Environmental Protection and Agriculture and the Ministry of Internally Displaced Persons from the Occupied Territories, Labor, Health and Social Affairs.

2- The latter assess the need for an impact assessment (screening phase), provide different orientations for the impact assessment framework (scoping phase – which health determinants and risks should be investigated) and supportive recommendations (appraisal) in case an impact assessment has to be carried out.

3- Based on the different expert recommendations, the Ministry of Environmental Protection and Agriculture is then making the decision on the approval/validation/permit/recommendations and their monitoring to the planning authority.

In this framework, the NCDC is responsible for the elaboration of a health statement and different recommendations to planning authorities in order to mitigate health negative impacts and maximize health benefits of project/plan/strategy.

The National Center for Disease Control and Public Health (NCDC) has partnered with Expertise France and the Finnish Institute of Health and Welfare (THL)  to implement a 24-month twinning project on health impact assessment. The project will be implemented with assistance from different public health and sanitary institutions in France, Finland and Czech Republic.

The overall purpose is for NCDC to align Georgian standards, guidelines and best practices from the European Union and from other international organizations on environmental health risk monitoring and management. Specific emphasis has to be put on improving population health and occupational safety at work, through prevention and control of communicable diseases, as well as prevention and control of non-communicable diseases, mainly through exchanging information and best practices. 

The twinning project is structured around four main areas of operation:

• Approximating Georgian legislation to EU directives in environmental health and to standards of EU Member States in carrying out Health Impact Assessments

• Building the technical and administrative capacities of NCDC for the implementation of HIA in Georgia

• Building partnerships between Georgian institutions and improving data value chain for HIA

• Improving public participation, involving civil society and better disseminating results.

1- Improving georgian Public Health legal and regulatory framework

The twinning project will compare environmental health provisions within the Georgian legislation and the different regulations in the EU and in the Association Agreement signed between the EU and the Government of Georgia. Whereas the Environmental Assessment Code is mostly in line with EU directives, some sanitary-hygienic norms, technical regulations and calculations are outdated and haven’t been revised to fit with EU Member State standards and practices (on noise or air pollution for instance). Technical parameters like measuring and the respective quality standards (e.g. microbiological, chemical, analytical, etc.) are in many cases not in line with the EU standards and practices.

2 & 3 - Supporting the NCDC and Georgian partners to implement Health Impact Assessments

Health Impact Assessment is a tool for public policy, legislation and projects to help mitigate negative health impacts and enhance positive ones of a given policy/project/legislation. It can be used for urban development, housing, construction/industrial and transport projects, and for health determinants (exposition to harmful substances like chemicals and air pollution). Most of the HIA in Georgia are executed on municipal and urban planning. The project will focus on different trainings to stakeholders (municipalities, urban design and architecture agencies) around “healthy city” and “healthy urban planning” (walkability, green and blue spaces, exposition to pollution, access to services, tobacco-free or junk-food free spaces close to schools…).

HIA uses a multi-disciplinary approach: it relies on environmental, health/medical but also social and economic data and methodologies. Vulnerable groups are usually the ones most exposed to harmful substances and with less access to information and resources to deal with exposure.

HIA provides decision-makers with:

• evidence-based analysis of health impacts of a project/policy
• recommendations on how to best mitigate its negative health impacts and enhance its positives ones
• a monitoring plan of the different recommendations.

The twinning project will support the NCDC in implementing HIA. Traineeships with the French School of Public Health (EHESP) will be organised. Experts will support the NCDC staff in implementing two pilot HIA on air pollution and on water pollution.

Other Georgian institutions will be involved in the process of conducting an HIA in order to get access to different data, especially Geostat and the National Environmental Agency. Institutional partnerships for common goal of improving environmental health will require consensus, data exchange protocols and trainings.

4- Improving public participation and communication

HIA relies on the principles of health democracy and transparency. It entails participation and consultations at the early stage of planning until the dissemination of recommendations and results to the public, as well as monitoring of recommendations for mitigating negative health impacts/maximizing health benefits.

According to the Environmental Assessment Code and the regulation on HIA, planning authorities are mandated to disseminate information and organize public hearings in order to present the project and reports. The NCDC is obliged to display information for dissemination and public involvement.

The twinning project supports the NCDC in fostering participation and engagement of civil society in HIA and environmental health, specifically through : 

• the elaboration of communication strategy and action plan for the NCDC on HIA ;
• the improvement of the current electronic platform and linkages with other relevant ones in Georgia ;
• the mobilization of working groups on environmental health and health promotion.

For more information about the twinning project, please be in touch with :

Antoine Pogorzelski, Resident Twinning Advisor: antoine.pogorzelski@expertisefrance.fr
Eka Lobzhanidze, RTA Assistant: e.lobzhanidze@ncdc.ge

To find out more about the presence of the European Union in Georgia:

https://eeas.europa.eu/delegations/georgia_en
https://eu4georgia.ge

This webpage has been produced with the assistance of the European Union. Its contents are the sole responsibility of Expertise France and do not necessarily reflect the views of the European Union.